2013 Community Health Needs Assessment Kaiser Foundation Hospital FREMONT License #140000053 To provide feedback about this Community Health Needs Assessment, email CHNA-communications@kp.org.
KAISER PERMANENTE NORTHERN CALIFORNIA REGION COMMUNITY BENEFIT CHNA REPORT FOR KFH-FREMONT I. Executive Summary The Patient Protection and Affordable Care Act (PPACA), enacted on March 23, 2010, added new requirements, which nonprofit hospital organizations must satisfy to maintain their taxexempt status under section 501(c)(3) of the Internal Revenue Code. One such requirement added by PPACA, Section 501(r) of the Code, requires nonprofit hospitals to conduct a community health needs assessment (CHNA) at least once every three years. As part of the CHNA, each hospital is required to collect input from designated individuals in the community, including public health experts as well as members, representatives or leaders of low income, minority, and medically underserved populations and individuals with chronic conditions. While Kaiser Permanente has conducted CHNAs for many years to identify needs and resources in our communities and to guide our Community Benefit plans, this new legislation has provided an opportunity to revisit our needs assessment and strategic planning processes with an eye toward enhanced compliance and transparency and leveraging emerging technologies. The CHNA process undertaken in 2013 and described in this report was conducted in compliance with these new federal requirements. Kaiser Foundation Hospital (KFH) Fremont submits this Community Health Needs Assessment in response to the federal requirements described in section 501(r) of the Internal Revenue Code and related excise tax and reporting obligations, applicable to hospital organizations that are (or seek to be) recognized as described in section 501(c)(3) of the Code. Kaiser Foundation Hospital Fremont has long valued a systematic approach for identifying community health needs in order to guide thoughtful and effective community benefit investment to make meaningful change. Kaiser Foundation Hospital Fremont has conducted Community Health Needs Assessments on a three year cycle under the requirements of California Senate Bill 697 (SB 697), enacted in 1994. This 2013 CHNA continues Kaiser Foundation Hospitals long standing commitment to the communities we serve by understanding their needs and assets in order to define where and how Kaiser Foundation Hospital Fremont community investments can have the greatest impact. Kaiser Foundation Hospital Fremont collaborated with Kaiser Foundation Hospital Hayward in the 2013 CHNA process. The process included a comprehensive review of secondary data on health outcomes, drivers, conditions and behaviors in addition to the collection and analysis of primary data through focus groups with members of vulnerable populations in our service area. We gathered input on the identified community health needs, and the relative priority among them, by convening the Community Benefits Advisory Group (CBAG) for the Greater Southern Fremont Community Health Needs Assessment 2
Alameda Area (GSAA), composed of a multicultural, multidisciplinary group of health and community health experts. The resulting prioritized list represents an understanding informed by both data and experience with particular relevance for vulnerable populations in the Kaiser Foundation Hospital Fremont service area (listed in priority order). Access to Preventive Health Care Services including Asthma Care (Language, Geographic, Cost) Access to Mental Health and Substance Use Treatment Services Access to a Safe Environment (Learn, Live, Work and Play) Access to Education and Training Programs (includes Parent Education) Exercise/Active Living Access to Affordable Healthy Food Access to Informational and Referral to Appropriate Programs II. Background and Introduction This report was written in order to comply with federal tax law requirements set forth in Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization described in Code section 501(c)(3) to conduct a community health needs assessment at least once every three years. The required written plan of Implementation Strategy is set forth in a separate written document. At the time that hospitals within Kaiser Foundation Hospitals conducted their CHNAs, Notice 2011 52 from the Internal Revenue Service provided the most recent guidance on how to conduct a CHNA. This written plan is intended to satisfy each of the applicable requirements set forth in IRS Notice 2011 52 regarding conducting the CHNA for the hospital facility. As a not for profit health system, Kaiser Foundation Hospitals have an obligation to make a charitable contribution to the community, but our commitment to keeping the communities we serve healthy goes far deeper than that. The mission Kaiser Permanente exists to provide affordable, high quality healthcare services to improve the health of our members and the communities we serve, accurately reflects our community health efforts as a corporate leader and community partner. The Patient Protection and Affordable Care Act, enacted March 23, 2010, requires that taxexempt hospitals conduct Community Health Needs Assessments and adopt implementation strategies to meet the health needs identified through the assessments. The CHNA requirements are among several new requirements that apply to section 501(c) (3) hospital organizations under section 501(r), which were added to the Code by section 9007(a) of the Patient Protection and Affordable Care Act, enacted March 23, 2010. Fremont Community Health Needs Assessment 3
Kaiser Foundation Hospital Fremont values a systematic approach to identifying community health needs and has completed a similar process in the past. Through collaborative community partnerships, Kaiser Foundation Hospital Fremont recently completed the Community Health Needs Assessment in accordance with the provisions of the PPACA. As a community based organization, Kaiser Foundation Hospital Fremont understands the value of continuously evaluating the health needs of the community it serves. By doing so, we are able to establish a systematic process for identifying community health needs that will guide thoughtful and effective community benefit investment for years to come. About Kaiser Permanente Founded in 1942 to serve employees of Kaiser Industries and opened to the public in 1945, Kaiser Permanente is recognized as one of America s leading health care providers and nonprofit health plans. We were created to meet the challenge of providing American workers with medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Since our beginnings, we have been committed to helping shape the future of health care. Among the innovations Kaiser Permanente has brought to U.S. health care are: Prepaid health plans, which spread the cost to make it more affordable A focus on preventing illness and disease as much as on caring for the sick An organized coordinated system that puts as many services as possible under one roof all connected by an electronic medical record Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, and physicians in the Permanente Medical Groups. Today we serve more than nine million members in nine states and the District of Columbia. Our mission is to provide high quality, affordable health care services and to improve the health of our members and the communities we serve. Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry leading technology advances and tools for health promotion, disease prevention, state of the art care delivery, and world class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. Fremont Community Health Needs Assessment 4
About Kaiser Foundation Hospital Fremont Structure Key Leadership at KFH Fremont Tom Hanenburg Debbie Hemker Charles Thevnin Calvin Wheeler, MD Victoria O Gorman Debra M. Lambert Arleen R. Carino Senior Vice President and Area Manager Chief Operating Officer Area Finance Director Physician in Chief Medical Group Administrator Public Affairs Director CB/CH Manager 2013 Community Health Needs Assessment Introduction The Affordable Care Act, enacted March 23, 2010, requires tax exempt hospitals to conduct community health needs assessments and to adopt implementation strategies to meet the health needs identified through the assessments. Kaiser Foundation Hospital Fremont has historically conducted a methodical approach to identifying community health needs and has completed a similar process in the past. As part of the SB 697 triennial cycle, a comprehensive community assessment was completed in 2010. The 2010 community assessment was conducted through collaboration with other health care providers in Southern Alameda County. The assessment included both a quantitative analysis of existing health data and a qualitative analysis of community focus group findings. Results of the assessment are made available to the public and are used to inform Kaiser Foundation Hospital Fremont s community benefit plan goals, priorities and strategies. For more than 65 years, Kaiser Permanente has been dedicated to providing high quality, affordable health care services and to improving the health of our members and the communities we serve. We believe good health is a fundamental right shared by all and we recognize that good health extends beyond the doctor s office and the hospital. It begins with healthy environments: fresh fruits and vegetables in neighborhood stores, successful schools, clean air, accessible parks, and safe playgrounds. These are the vital signs of healthy communities. Good health for the entire community, which we call Total Community Health, requires equity and social and economic well being. Like our approach to medicine, our work in the community takes a prevention focused, evidence based approach. We go beyond traditional corporate philanthropy or grantmaking to pair financial resources with medical research, physician expertise, and clinical practices. Historically, we ve focused our investments in three areas Health Access, Healthy Communities, and Health Knowledge to address critical health issues in our communities. Fremont Community Health Needs Assessment 5
For many years, we ve worked side by side with other organizations to address serious public health issues such as obesity, access to care, and violence. And we ve conducted the CHNA s to better understand each community s unique needs and resources. The CHNA process informs our community investments and helps us develop strategies aimed at making long term, sustainable change and it allows us to deepen the strong relationships we have with other organizations that are working to improve community health. Kaiser Permanente s Approach to Community Health Needs Assessment About the new federal requirements Federal requirements included in the PPACA, which was enacted March 23, 2010, stipulate that hospital organizations under 501(c)(3) status must adhere to new regulations, one of which is conducting a CHNA every three years. With regard to the CHNA, the PPACA specifically requires nonprofit hospitals to: collect and take into account input from public health experts as well as community leaders and representatives of high need populations this includes minority groups, low income individuals, medically underserved populations, and those with chronic conditions; identify and prioritize community health needs; document a separate CHNA for each individual hospital; and make the CHNA report widely available to the public. In addition, each nonprofit hospital must adopt an Implementation Strategy to address the identified community health needs and submit a copy of the Implementation Strategy along with the organization s annual Form 990. SB 697 and California s history with past assessments For many years, Kaiser Permanente hospitals have conducted needs assessments to guide our allocation of Community Benefit resources. In 1994, California legislators passed Senate Bill 697, which requires all private nonprofit hospitals in the state to conduct a CHNA every three years. As part of SB 697 hospitals are also required to annually submit a summary of their Community Benefit contributions, particularly those activities undertaken to address the community needs that arose during the CHNA. Kaiser Permanente has designed a process that will continue to comply with SB 697 and that also meets the new federal CHNA requirements. Kaiser Permanente s CHNA framework and process Kaiser Permanente Community Benefit staff at the national, regional, and hospital levels worked together to establish an approach for implementing the new federally legislated CHNA. From data collection and analysis to the identification of prioritized needs and the development of an Implementation Strategy, the intent was to develop a rigorous process that would yield meaningful results. Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and the Center for Applied Research and Environmental Studies (CARES), developed a webbased CHNA Data Platform to facilitate implementation of the CHNA process. Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. Fremont Community Health Needs Assessment 6
To ensure a minimum level of consistency across the organization, Kaiser Permanente included a list of roughly 100 indicators in the data platform that, when looked at together, help illustrate the health of a community. California data sources were used whenever possible. When California data sources weren t available, national data sources were used. Once a user explores the data available, the data platform has the ability to generate a report that can be used to guide primary data collection and inform the identification and prioritization of health needs. In addition to reviewing the secondary data available through the CHNA Data Platform, and in some cases other local sources, each hospital collected primary data through key informant interviews, focus groups, and surveys. They asked local public health experts, community leaders, and residents to identify issues that most impacted the health of the community. They also inventoried existing community assets and resources. Each hospital/collaborative used a set of criteria to determine what constituted a health need in their community. Once all of the community health needs were identified, they were all prioritized, based on a second set of criteria. This process resulted in a complete list of prioritized community health needs. The process and the outcome of the CHNA are described in this report. In conjunction with this report, Kaiser Permanente will develop an Implementation Strategy for each health need identified. These strategies will build on Kaiser Permanente s assets and resources, and evidence based strategies, wherever possible. The Implementation Strategy will be filed with the Internal Revenue Service using Form 990 Schedule H. III. Community Served The KFH Fremont service area covers the southern part of Alameda County. The cities served include Fremont and Newark. TABLE 1: DEMOGRAPHIC PROFILE OF THE KAISER FOUNDATION HOSPITAL FREMONT SERVICE AREA Total population: 251,245 Caucasian: 91,887 Population: no high school diploma 9.91% Latino: 43,543 Number of Uninsured: 21,265 African American: 8,689 Percentage living in poverty: 5.56% Asian: 114,173 Percentage children 0 17 living in poverty: 6.40% Pacific Islander: 2,574 Percentage uninsured: 8.44% Native American: 1,096 Fremont Community Health Needs Assessment 7
Kaiser Permanente defines the community served by a hospital as those individuals residing within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low income or underserved populations. The map of the KFH Fremont service area is shown below. The primary focus of our Community Benefit programs is on the needs of vulnerable populations. We define vulnerable populations as those with evidenced based disparities in health outcomes, significant barriers to care and the economically disadvantaged. These criteria result in a primary Community Benefit Service Area that includes neighborhoods in the communities of Fremont and Newark. The populations at the highest risk (highest poverty rates, lowest levels of health insurance and lowest rates of high school degree completion) in these areas are African Americans and Latinos. Fremont Community Health Needs Assessment 8
IV. Collaboration for the 2013 Community Health Needs Assessment Kaiser Foundation Hospital Fremont and Kaiser Foundation Hospital Hayward conducted this Community Health Needs Assessment. These two hospitals serve the populations in Southern Alameda County. Kaiser Foundation Hospital Fremont contracted with Nancy Shemick to complete the data analysis required for the Community Health Needs Assessment. Ms. Shemick also designed and facilitated primary data collection as well as a prioritization session that engaged the Community Benefits Advisory Group. Ms. Shemick holds a Masters Degree in Public Administration and has been working with community and public health data for over 35 years. She completed the required California SB 697 Community Health Needs Assessments for Kaiser Foundation Hospitals in Fremont and Hayward in 2004, 2007, and 2010. Ms. Shemick has also worked as a consultant to the numerous community health centers and other agencies in Alameda County. She conducts data analysis, supports process improvement, performs strategic planning for health care nonprofits, and conducts group facilitation. V. Process and Methods Used to Conduct the Community Health Needs Assessment Secondary data. The majority of the secondary data used in this CHNA are available through the Kaiser Permanente CHNA Data Platform, powered by CARES and IP3. These data are organized into six distinct categories: Demographics. The source for demographic data is the US Census Bureau, 2006 2010 American Community Survey 5 year estimates. Social and Economic Factors. These data were from the following sources: o US Census Bureau, American Community Survey 2006 2010 5 year estimates and 2008 2010 3 year estimates o Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006 2010 o US Department of Education, National Center for Education Statistics (NCES), Common Core of Data, Public School Universe File, 2009 2010 and Local Education Agency (School District) Universe Survey Drop out and Completion Data, 2008 2009 o States Department of Education, Student testing Reports, 2011 o US Census Bureau, Small Area Income and Poverty Estimates (SAIPE), 2009 o US Bureau of Labor Statistics, July 2012 Local Area Unemployment Statistics o US Federal Bureau of Investigation, Uniform Crime Reports, 2010 Fremont Community Health Needs Assessment 9
Physical Environment, including data from the following sources: o US Census Bureau, ZIP Code Business Patterns, 2009 and County Business Patterns, 2010 o California Department of Alcoholic Beverage Control, Active License File, April 2012 o US Census Bureau, 2010 Census of Populations and Housing, Summary File 1;Esru s USA Parks layer (compilation of Esri, National Park Services and TomTom source data) 2012 o Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network, 2008 o US Department of Agriculture, Food Desert Locator, 2009 o Walkscore.com 2012 o US Department of Agriculture, Food Environment Atlas, 2012 Clinical Care data from the following sources: o California Health Interview Survey (CHIS) 2005, 2007, and 2009 o US Health Resources and Services Administration Area Resource File 2009 (as reported in the 2012 County Health Rankings) and Health Professional Shortage Area File 2012 o Dartmouth Atlas of Healthcare, Selected Measures of Primary Care Access and Quality 2003 2007 o Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2004 2010 o US Health Resources and Services Administration Centers for Medicare and Medicaid Services, Provider of Service File, 2011 o California Department of Public Health Birth Profiles by ZIP code, 2010 o California Office of Statewide Health Planning and Development (OSHPD), Patient Discharge Data, 2010 Health Behaviors data from the following sources: o California Health Interview Survey (CHIS) 2009 o Nielsen Claritas Site Reports Consumer Buying Power, 2011 o California Department of Public Health, In Hospital Breastfeeding Initiations Data, 2011 Fremont Community Health Needs Assessment 10
o Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2004 2010 o California Department of Education, Fitnessgram Physical Fitness Testing Results, 2011 Health Outcomes data, based on incidence and mortality. o OSHPD, Patient Discharge Data, 2010 o Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2004 2010 o Centers for Disease Control and Prevention and the National Cancer Institute: State Cancer Profiles, 2005 2009 o California Department of Public Health, Death Statistical Master File, 2008 2010 o Centers for Disease Control and Prevention and the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 2009 o Centers for Disease Control and Prevention, National Diabetes Surveillance System, 2009 o California Health Interview Survey (CHIS) 2009 o California Department of Education, Fitnessgram Physical Fitness Testing Results, 2011 o Centers for Disease Control and Prevention, National Vital Statistics System, 2008 2010 (As reported in the 2012 County Health Rankings) The statisticians at CARES used data from the sources listed above to create the Kaiser Permanente CHNA Data Platform. The platform analysis of data by geographic areas is limited by the geography for which the data were originally collected. Health Outcomes data from the platform were downloaded for Kaiser Foundation Hospital Fremont and compared to benchmarks defined either by Healthy People 2020, relevant Countylevel rates or State level rates. After identifying those outcome indicators for which the population in the Kaiser Foundation Hospital Fremont service area were seen to compare poorly to benchmarks, associated indicators of health (health behaviors, clinical care, physical environment and social and economic factors) were reviewed and analyzed to see where these indicators also showed poor performance relative to benchmarks. Based on the combined analysis described above, a set of community health concerns were identified and served as the basis for a facilitated Community Benefits Advisory Committee as described below. Fremont Community Health Needs Assessment 11
Community Input Kaiser Foundation Hospital Fremont and Kaiser Foundation Hospital Hayward derived community input in two forms. First, the findings regarding community health concerns were gathered from the secondary data (as described above) discussed with groups of people from underserved, minority and low income populations. The results of these focus groups were considered along with the secondary data, and a set of Community Health Needs was identified using the following guidelines: The community health need arises from comprehensive review and interpretation of a robust set of data More than one indicator and/or data source (i.e., the health need is suggested by more than one source of secondary and/or primary data) confirms the community health need Indicator(s) related to the health need perform(s) poorly against a defined benchmark (e.g., state average or HP 2020) The community focus groups identified drivers(s) that are associated with the poor health outcome. The defined list of Community Health Needs was shared and discussed with a meeting of the Greater Southern Alameda Area Community Benefits Advisory Group who were asked to determine relative priority among the needs using established criteria (described below). Focus Groups Community agencies serving the relevant populations recruited three groups of community members. The groups ranged from 12 26 participants and were held in communities with high rates of poverty, low rates of high school graduation and relatively low rates of insurance coverage. One of the groups was held in Spanish with Latino residents in Fremont, one with low income residents in Fremont and one with multicultural high risk low income high school aged youth. The community agencies with which Kaiser Foundation Hospitals partnered for these community conversations recruited the individuals and provided space, and Kaiser Permanente paid the cost of food and thank you gifts for the participants. The table below shows the specific partner agencies, the conversation language, the number of individuals present and the target populations from which they were drawn (minority, low income, chronic conditions, etc.) All of the community conversations took place between October 1 and December 15, 2012. Fremont Community Health Needs Assessment 12
TABLE 2: FOCUS GROUPS IN SOUTHERN ALAMEDA COUNTY Partner Agency Language Number of Age Populations Represented Participants Range Fremont Human Services English 19 35 65+ Afghan, African American, Latino, East Indian, Caucasian Tiburcio Vasquez Spanish 26 15 65+ Latino, Caucasian Health Center SoulCiety English 14 14 30 Latino, Fijian, African American, Caucasian, Filipino Expert Stakeholders Expert stakeholders were interviewed either in person or via telephone to review the secondary data findings and the focus group input especially regarding associated drivers specific to the poor health outcomes. The expert stakeholders concurred and shared their thoughts on the impact that some of the drivers have on poor health outcomes, and also made suggestions on assets in the area that may be able to address the drivers. The assets mentioned are listed in the assets table. The following key informants were interviewed during the period from December 2012 to January 2013. TABLE 3: PUBLIC AND COMMUNITY HEALTH EXPERTS Name and Title Agency Represented Area of Expertise Mark Friedman, Exec. Director First Five Alameda County Public Health Expert Family and community resources Children ages 0 5 and policies Chuck McKetney, PhD, Epidemiologist Alameda County Public Health Dept. Public Health Expert County Data Muntu Davis, MD, MPH Alameda County Public Health Dept. Public Health Expert Director Alex Briscoe, Director Ron Carino, Exec. Director Aaron Horner, Chief Operating Officer Mary Schlarb, COR Leader Alameda County Health Care Services Agency SoulCiety SoulCiety Congregations for Organizing and Renewal (COR) Health Inequities Public Health Expert Youth, Human Services and Community Health Community Leader, Youth development Community Leader, Youth development Community Leader, Community and youth resources Fremont Community Health Needs Assessment 13
Data Limitations The Kaiser Permanente common data set includes a robust set of nearly 100 secondary data indicators that, when taken together, enable an examination of the broad health needs faced by a community. However, there are some limitations with regard to this data, as is true with any secondary data available. Some data were only available at a county level, making an assessment of health needs at a neighborhood level challenging. Moreover, disaggregated data around age, ethnicity, race, and gender are not available for all data indicators, which limited the ability to examine disparities of health issues within the community. Lastly, data are not always collected on a yearly basis, meaning that some data are several years old. The biggest challenge to the clear analysis and interpretation of data was the variation in granularity across the relevant indicators of health status and health outcomes. In many cases data are only available at the county level, which makes careful analysis for specific target communities very difficult. Based on the experience of the expert stakeholders as well as the direct information we received from members of under served or at risk populations, we are confident that the community health needs we identified have a significant impact on vulnerable populations. VI. Identification and Prioritization of Community Health Needs Kaiser Foundation Hospital Fremont along with Kaiser Foundation Hospital Hayward identified a list of seven community health needs. The working definition of a community health need is as follows: The community health need arises from comprehensive review and interpretation of a robust set of data. More than one indicator and/or data source (i.e., the health need is suggested by more than one source of secondary and/or primary data) confirms the community health need. Indicator(s) related to the health need perform(s) poorly against a defined benchmark (e.g., state average or HP 2020, whatever is available). Poor health outcomes and associated drivers(s). Community Health Needs for the Kaiser Foundation Hospital Fremont service area were defined and prioritized through the following sequential steps: 1. Analysis of secondary data on health outcomes, identifying all of the health outcomes for which the data showed poor performance relative to benchmark. Fremont Community Health Needs Assessment 14
2. For each of the health outcomes showing poor performance, related health drivers, behaviors and conditions were also analyzed to determine which are of concern in Southern Alameda County and thus are likely to be factors contributing to the health outcome (See Table below). 3. Conversations with community members via focus groups to test the data findings, assess community knowledge about the issue and understand available community resources. 4. A synthesis of all of the data and conversations to define a set of community health needs. 5. Interviews with Key Informants (public and community health experts) to test the set of community health needs. 6. Discussion of the community health needs with the GSAA Community Benefits Advisory Group, familiar with issues in the Southern Alameda area (See list of criteria and prioritized community health needs below). The CBAG members reviewed Table 4, and discussed it for clarity and understanding. In order to prioritize the table of health outcomes and their associated drivers (a product of steps 1 4 above), the CBAG members discussed and agreed to use the following six criteria to conduct the prioritization process. 1. Severity of issue/impact of related poor health outcomes 2. Size of the population affected 3. Community prioritizes issue over others 4. Effective and feasible interventions exist 5. A successful solution/intervention has the potential to solve multiple problems 6. Opportunity to intervene at the prevention level Fremont Community Health Needs Assessment 15
TABLE 4: SOUTHERN ALAMEDA COUNTY COMMUNITY HEALTH NEEDS, POOR HEALTH OUTCOMES AND COMMUNITIES OF CONCERN Community Health Need Related Poor Health Outcomes Geographic Area of Most Concern Exercise/Active Living Chronic diseases, Poor Mental Health and Overweight/Obesity All Communities Access to Affordable Healthy Diabetes and Food Overweight/Obesity Fremont, Ashland, Cherryland Access to Preventive Health Care Services (language, geographic, cost) Chronic diseases, Diabetes, Asthma, Poor Mental Health and Cancer All Communities Access to Mental Health and Substance Use Treatment Services Access to education and training programs Poor Mental Health and Homicide and Violence Violence, poor mental health Fremont, Ashland, Cherryland Fremont, Ashland, Cherryland TABLE 5: FREMONT POOR HEALTH OUTCOMES AND BENCHMARKS Health Outcome Fremont Benchmark Adult asthma hospitalizations per 100,000 13.5 State 7.1 Youth asthma hospitalizations per 100,000 26.43 State 19.18 Asthma ED visits/100,000 children under 5 1690 State 883 Adult overweight prevalence 36.77% State 23.25% Youth overweight prevalence 14.57% State 14.3% Youth obesity prevalence 33.75% State 29.81% Adult diabetes discharges per 100,000 10.5 State 9.86 Heart disease mortality per 100,000 105 HP2020 <=100.8 Stroke mortality per 100,000 42.90 State 39.5 Breast cancer incidence per 100,000 128.2 State 123.2 Colorectal cancer incidence per 100,000 45.5 HP2020 <=38.6 Prostate cancer incidence per 100,000 150.80 State 143 Suicide death rate per 100,000 10.1 HP2020 <=10.2 Mental health ED visits per 100,000 1150.6 County 925.0 Homicide rate per 100,000 10.7 HP2020 <=5.5 Teen births 46 State 35.2 Fremont Community Health Needs Assessment 16
TABLE 6: POOR HEALTH OUTCOMES AND RELATED HEALTH DRIVERS, BEHAVIORS AND CONDITIONS IN SOUTHERN ALAMEDA COUNTY Teen Births Health Outcomes Asthma Unintentional Injury Mortality Child Overweight and Obesity Diabetes Mortality Coronary Heart Disease and Stroke Mortality Breast Cancer Colorectal cancer Mental Health Disorders Assault and Homicide Preventable Hospitalizations Related Health Drivers, Behaviors and Conditions Seen in Southern Alameda County1 High school graduation rate,liquor store access, Heavy Alcohol Consumption, Poverty Rate, Children Living in Poverty Poor Air Quality, Tobacco expenditures, Obesity High school graduation rate, Walkability, Liquor store access Heavy Alcohol Consumption, Poverty Rate Youth physical inactivity, Grocery Store Access, WIC authorized food store access, Population living in food deserts, Park access Soft drink expenditures, Fruit and vegetable expenditures Obesity, Youth physical inactivity, Grocery Store Access WIC authorized food store access, Population living in food deserts, Park access, Soft drink expenditures, Fruit and vegetable expenditures, Adequate fruit and vegetable consumption, Walkability, Fast food restaurant access Diabetes, Walkability, Heavy Alcohol Consumption Student reading proficiency, High school graduation rate Youth physical inactivity, Tobacco expenditures, Park access Obesity Heavy Alcohol Consumption Grocery Store Access, WIC authorized food store access Walkability, Fast food restaurant access, Fruit and vegetable expenditures, Heavy Alcohol Consumption Walkability, High school graduation rate, Youth physical inactivity, Heavy Alcohol Consumption Heavy alcohol consumption, Poverty Rate Uninsurance rate, Access to linguistically and culturally appropriate primary and specialty care 1 The related health drivers, behaviors and conditions that are listed here were identified through a literature search conducted by Kaiser Permanente and are included in this table if the available data show that the specific driver, behavior or condition performs poorly relative to the benchmark for Alameda County. Fremont Community Health Needs Assessment 17
Criteria Used to Prioritized Among Community Health Needs The GSAA Community Benefits Advisory Group, familiar with issues in the Southern Alameda area discussed and ranked the above community health needs using the following criteria: 1. Severity of issue/impact of related poor health outcomes 2. Size of the population affected 3. Community prioritizes issue over others 4. Effective and feasible interventions exist 5. A successful solution/intervention has the potential to solve multiple problems 6. Opportunity to intervene at the prevention level Ranking TABLE 7: PRIORITIZED LIST OF COMMUNITY HEALTH NEEDS Community Health Need 1 Access to Preventive Health Care Services including Asthma Care (Language, Geographic, Cost) 2 tied Access to Mental Health and Substance Use Treatment Services 2 tied Access to a Safe Environment (Learn, Live, Work and Play) 3 Access to Education and Training Programs (includes Parent Education) 4 Exercise/Active Living 5 Access to Affordable Healthy Food 6 Access to Information and Referral to Appropriate Programs VII. Community Assets and Resources Available to Respond to the Identified Health Needs of the Community Table 8 below shows community assets and resources related to the identified needs of the community. Fremont Community Health Needs Assessment 18
TABLE 8: SIGNIFICANT COMMUNITY ASSETS AND RESOURCES RELATED TO COMMUNITY HEALTH NEEDS Community Health Needs Existing Community Assets and Resources Access to Preventive Health Care Services including Asthma Care (Language, Geographic, Cost) Access to Mental Health and Substance Use Treatment Services Access to a Safe Environment (Learn, Live, Work and Play) Access to Education and Training Programs (Includes Parent Education) Exercise/Active Living Access to Affordable Healthy Food Access to Informational and Referral to Appropriate Programs Grupo VIP Fremont Abode Services Friends of Alameda County Court Appointed Special Advocates Drivers for Survivors Alameda Health Consortium Tri City Health Center NAMI Alameda County South Alameda County Health Care Services Agency Eden Youth and Family Service s Tattoo Removal Program First Five Community Child Care Council (4C s) of Alameda County Calico Center Safe Alternatives to Violent Environments (SAVE) First Five Community Child Care Council (4C s) of Alameda County City of Fremont Youth and Family Services City of Fremont Parks and Recreation Dept. Community Child Care Council (4C s) of Alameda County Alameda County Public Health Department Alameda County Food Bank Alameda County Office of Education Building Blocks Collaborative Eden Information and Referral Tri City Health Center East Bay Agency for Children Fremont Resource Center Fremont Community Health Needs Assessment 19
Appendix: Community Health Need Profiles 1. Access to Preventive Health Care Services including Asthma Care (Language, Geographic, Cost) is a significant need for low income residents in Southern Alameda County. Improved primary care access could have a positive effect on several of the poor health outcomes, particularly diabetes, asthma hospitalizations, heart disease and stroke mortality, and preventable hospital admissions. Rationale: Health care providers indicate that preventive care access is limited for low income residents of Southern Alameda County. County Indicators and Health Outcomes Health Outcomes Benchmarks Related Factors Diabetes discharges: 4.31 Heart disease mortality = 99.3/100,000 Stroke mortality = 28.40/100,000 Youth asthma hospitalizations: 8.62/10,000 Prostate Cancer death rate: 150.50/100,000 African Americans: 219.80/100,000 Age adjusted diabetes discharge rate = 10.4/10,000 HP 2020 Heart Disease mortality < = 100.8 Stroke mortality = 39.46 State average: 8.9/10,000 State average: 143/100,000 Insurance rate Access (including transportation access) to culturally/linguistically appropriate prevention services Access to culturally/linguistically appropriate primary care and care management (including medications) Access to culturally/linguistically appropriate primary care and care management (including medications) Insurance rate Access (including transportation access) to culturally /linguistically appropriate prevention services Access (including transportation access) to culturally /linguistically appropriate prevention services Access to culturally/linguistically appropriate primary care (including medications) Access (including transportation access) to culturally /linguistically appropriate prevention services Primary Data Summary: The wait time for new patients at some community clinics is long. Spanish speakers confront barriers to care due to information and materials not available in Spanish. Some services such as a specialty care, require a trip to Highland Hospital in Oakland, with long lines. Fremont Community Health Needs Assessment 20
2. Access to Mental Health and Substance Use Treatment Services. Affordable, local mental health services are needed to support families and youth and to limit the negative impact from poor mental health status (including violence). Rationale: Mental health status has an impact through intentional violence (suicide, homicide) as well as general quality of life and ability to be productive. Southern Alameda County Indicators and Health Outcomes Health Outcomes Benchmarks Related Factors Poor mental health = 14.78% State poor mental health: 14.21% Suicide death rate = 9.3/100,000 Suicide death rate <=10.2/100,000 Homicide death rate = 5.4/100,000 Newark homicide death rate: over 12/100,000 Percent heavy alcohol drinkers: 18.8% Homicide death rate = <5.5/100,000 State percent heavy alcohol drinkers: 16.80% Access (including transportation access) to culturally /linguistically appropriate behavioral health services Primary Data Summary: Parents are not able to speak to their children about drug use. Youth say that they are depressed, find themselves self medicating with alcohol and drugs. Youth experience bullying and pressure to join gangs. Girls say that boys in school can be physically abusive and they have nowhere to turn. Spanish speakers feel that there are not enough programs that can help them in Spanish. Fremont Community Health Needs Assessment 21
3. Access to a Safe Environment (Learn, Live, Work and Play) is needed to improve multiple health outcomes, including obesity, diabetes, cardiovascular disease, and mental health. In addition, intentional injuries such as assault and homicide, are less likely. Rationale: A lack of exercise and physical activity contributes to multiple poor health outcomes. Parents and youth in Fremont indicated that they are concerned about both safety and costs related to having their children in parks and youth sports. Southern Alameda County Indicators and Health Outcomes Health Outcomes Benchmarks Related Factors Youth overweight = 13.60% Hispanic: 15.74% African American: 17.32% White: 14.95% Youth overweight = 14.3% Diabetes discharges = 4.31/10,000 Age adjusted diabetes discharge rate = 10.4/10,000 Heart disease mortality = 99.30/100,000 Stroke mortality = 28.40/100,000 Heart disease mortality = 100.8/100,000 Stroke mortality = 39.46/100,000 Poor mental health = 14.78% State poor mental health: 14.21% Suicide death rate = 9.3/100,000 Suicide death rate <=10.2/100,000 Homicide death rate = 5.4/100,000 Newark homicide death rate: over 12/100,000 Homicide death rate = <5.5/100,000 Physical inactivity Park access Walkability Primary Data Summary: Unhealthy youth activity, such as gangs and illicit drug and alcohol use is a concern of parents in lower income areas. A reduction in free after school and other youth programs along with costly soccer and other league sports make them inaccessible to lower income, vulnerable families. Safety concerns prohibit parents from allowing their children to play outdoors after school. Parents are holding down several jobs are not able to spend time outdoors with their children. Fremont Community Health Needs Assessment 22
4. Access to Education and Training Programs (includes Parent Education) In the youth and parent group discussions in Fremont, the low high school graduation rate was of grave concern. Parents recognized the importance of good role modeling, as many themselves are not high school graduates. Parenting skills and support were identified as a need by all of the community groups. The need relates to understanding how to raise children in a healthy way, using effective discipline as well as good cooking and eating habits. Parents also wanted skills and support in addressing mental health and substance use/abuse issues with their children. Rationale: Parents felt that improved skills and support is a critical need in families that are isolated (immigrants in particular) or where parents are struggling to manage jobs, commutes and children. Southern Alameda County Indicators and Health Outcomes Health Outcomes Benchmarks Related Factors Poor mental health = 14.78% State poor mental health: 14.21% Suicide death rate = 9.3/100,000 Suicide death rate <=10.2/100,000 Homicide death rate = 5.4/100,000 Newark homicide death rate: over 12/100,000 Homicide death rate = <5.5/100,000 Diabetes discharges = 4.31/10,000 Age adjusted diabetes discharge rate = 10.4/10,000 Youth overweight = 13.60% Hispanic: 15.74% Youth overweight = 14.3% African American: 17.32% White: 14.95% High school graduation rate Employment rate Youth tobacco expenditures Youth drug and alcohol use Poverty rate High school graduation rate Employment rate Primary Data Summary: Parents are having difficulties making their mortgage payments or apartment rents on time. They spend more time working to pay their bills and some of the youth stated that they are pressured by parents to quit high school to get a job. Because the youth do not see much value in attending school these pressures easily influence the youth. Many of lower income people stated that they do not have role models who have successfully graduated high school. A number of youth do not see their high school environments as being pleasant (due to bullying, gang influences, racism, etc.) so they are not motivated to stay in school. Fremont Community Health Needs Assessment 23
5. Exercise/Active Living is required to improve multiple health outcomes, including obesity, diabetes, cardiovascular disease, and mental health. Rationale: A lack of exercise and physical activity contributes to multiple poor health outcomes. Parents and youth in Fremont indicated that they don t have time to exercise, are concerned about both safety and cost related to having their children in parks and youth sports Southern Alameda County Indicators and Health Outcomes Health Outcomes Benchmarks Related Factors Youth overweight = 13.60% Hispanic: 15.74% African American: 17.32% Youth overweight = 14.3% White: 14.95% Diabetes discharges = 4.31/10,000 Age adjusted diabetes discharge rate = 10.4/10,000 Heart disease mortality = Heart disease mortality = 100.8/100,000 99.30/100,000 Stroke mortality = 39.46/100,000 Stroke mortality = 28.40/100,000 Poor mental health = 14.78% State poor mental health: 14.21% Physical inactivity Park access Walkability Primary Data Summary: Not enough time to exercise. Local gyms charge too much for membership. A reduction in free after school and other youth programs along with costly soccer and other league sports make them inaccessible to lower income, vulnerable families. Fremont Community Health Needs Assessment 24
6. Access to Affordable Healthy Food is a significant need in order to address several of the poor health outcomes, including obesity and overweight, diabetes, and cancers. Rationale: Several of the poor health outcomes are related to poor eating habits. Many related economic and social factors show that healthy food is less available to vulnerable populations. Focus groups commented that they feel there is a higher concentration of fast food establishments available in Fremont than overall in California. Southern Alameda County Indicators and Health Outcomes Health Outcomes Benchmarks Related Factors Adult overweight = 36.77% Youth overweight = 13.60% Adult overweight = 36.20% Youth overweight = 14.3% Diabetes discharges = 4.31/10,000 Age adjusted diabetes discharge rate = 10.4/10,000 Cancers: Breast Cancer incidence = 128.2/100,000 Colorectal Cancer incidence = 45.20/100,000 African American = 56.50 Prostate cancer = 150.50/100,000 African American = 219.80/100,000 Fruit and vegetable expenditures: 1.54% of total income 70.10 Fast food establishments/100,000 Breast cancer incidence = 123.30 Colorectal cancer incidence = 38.6/100,000 Prostate cancer incidence = 143/100,000 State average for fruit and vegetable expenditures: 1.64% of total income 68.35 fast food establishments/100,000 Inadequate fruit and vegetable consumption Fruit and vegetable expenditures Grocery store access WIC authorized food store access Populations living in food desert Primary Data Summary: Parents know what healthy foods they should eat, but state that they are unable to prepare healthy food, due to busy schedules and their children s preferences. They also state that fast food is much more accessible than fresh produce. Healthy food is more expensive and less convenient than fast food. Calorie dense traditional foods are served at family functions and are difficult habits to change. Fremont Community Health Needs Assessment 25
7. Access to Information and Referral to Appropriate Programs Newly arrived immigrants to the area find themselves isolated from the resources that help them. Access to services and programs along with assistance that can help them improve their access to primary care and other human services. Rationale: Improved access to services could have a positive effect on several of the poor health and mental health outcomes, particularly diabetes, mental health ED visits, asthma hospitalizations, heart disease and stroke mortality, and preventable hospital admissions. Southern Alameda County Indicators and Health Outcomes Health Outcomes Benchmarks Related Factors Diabetes discharges = 4.31/10,000 Age adjusted diabetes discharge rate = 10.4/10,000 Asthma hospitalizations: 8.62/10,000 State average: 8.9/10,000 Uninsurance rate Poor mental health = 14.78% State poor mental health: 14.21% Primary Data Summary: All focus group participants stated that the many newly arrived immigrants in Southern Alameda County are isolated and need to be connected to services geared to support them Parents pointed to the need to learn about the resources available to them in the areas of health and social services. Fremont Community Health Needs Assessment 26