Community Health Needs Assessment

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1 2013 Community Health Needs Assessment Kaiser Foundation Hospital PANORAMA CITY License # To provide feedback about this Community Health Needs Assessment,

2 Authors Valley Care Community Consortium was contracted to prepare a Community Health Needs Assessment for the Kaiser Permanente Panorama City Medical Center Service Area. Joni Novosel, MS Health Administration Surekha Vasant, MS Public Health VCCC contributing authors (health profiles, data tables, and asset mapping) Kenia Alcaraz, BS Public Health Maribel Aguilar, BS Health Education Belen Arangure, BS Health Education Ines Herrera, BS Public Health Shivani Ponnambalavan, Dual MS Human Resources and Health Administration VCCC subcontracted with Antelope Valley Partners for Health for the portions of the report pertaining to Antelope Valley including the cities of Lancaster and Palmdale. Michelle Kiefer, MBA Tiara Sigaran, BS Public Health Trish Bogna, BS Business Management Valley Care Community Consortium 7515 Van Nuys Blvd., Fifth Floor Van Nuys, CA Telephone: Website: I

3 Acknowledgements Conducting a community health needs assessment is no small task and would not be possible without the contributions of VCCC staff, Antelope Valley Partners for Health (AVPH), Los Angeles County Department of Public Health, our VCCC partner agencies including KFH- Panorama City, and community residents. We would like to give a special thanks to the graduate and undergraduate health administration and public health interns working with us from California State University Northridge and Los Angeles. We would like to extend a special acknowledgement to AVPH, who as a sub-contractor with VCCC provided primary and additional local secondary data. VCCC acknowledges and honors AVPH s contribution of time, dedication, and expertise in identifying the community health needs in the Antelope Valley including the cities of Lancaster and Palmdale. We would like to recognize and acknowledge our local KFH- Panorama City Public Affairs Director and her Community Benefits staff for their ongoing guidance and support. In addition we appreciate the technical assistance and leadership from the Kaiser Permanente Regional Office. Their efforts have been instrumental in completing this report. The list of individuals representing multiple agencies are too many to name individually, however we want to express our gratitude to those agencies that supported VCCC and AVPH through participation in key informant interviews, focus groups, community forums, and prioritization meetings. Agencies represented include: All 4 Children Antelope Valley Community Clinic Antelope Valley Healthcare District Antelope Valley Hospital Antelope Valley Partners for Health Antelope Valley Pregnancy Counseling Center Asian Youth Center AV Chess House AV Mobility Management Project Bartz-Altadona Community Health Center Black Infant Health California State University, Northridge Catalyst Foundation Child and Family Guidance Center Children Center of the Antelope Valley Children s Bureau Church on The Way City of San Fernando Community Synergy for Children and Families CSUN El Nido Family Center Friends of the Family Lancaster Department of Children and Family Services Lancaster School District Los Angeles Community Development Commission Los Angeles County Department of Mental Health SA 1 and SA 2 Los Angeles County Department of Public Health II

4 Los Angeles County Office of Education Los Angeles County, High Desert Health System Los Angeles County, ValleyCare Health System Los Angeles Department of Children and Family Services Los Angeles Unified School District MEND Menfolk Mental Health America Mid Valley Comprehensive Health Center Mission Community Hospital National Alliance for Mental Illness (NAMI) Neighborhood Legal Services New Directions for Youth Northeast Valley Health Corporation Olive View UCLA Medical Center Open Arms Foster Age Palmdale School District Partners in Care Foundation Protective Science Dynamics Providence Access to Care PSD Head Start SCAN Tarzana Treatment Center Two Life Styles Valley Trauma Center Yes 2 Kids We would also like to thank the data committee. The data committee consists of area academic, health and public health service providers that meet on a monthly basis to provide guidance throughout all stages of the needs assessment process. H-sin Chen, MSHA Tarzana Treatment Center Regan Mass, Ph.D California State University Northridge, Geography Dept. Gigi Mathew, Dr.PH Research Analyst III Los Angeles County Department of Public Health Office of Health Assessment and Epidemiology Marie Mayen-Cho, MPH Providence Access to Care Collaborative Douglas Melnick, MD, MPH Los Angeles County Department of Public Health Ronald Sorensen, MSHA Providence Health & Services Center for Community Health III

5 Table of Contents AUTHORS... I ACKNOWLEDGEMENTS... II GLOSSARY OF TERMS... 4 I. EXECUTIVE SUMMARY... 8 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) BACKGROUND... 8 SUMMARY OF NEEDS ASSESSMENT METHODOLOGY AND PROCESS... 8 SUMMARY OF PRIORITIZED NEEDS II. INTRODUCTION/BACKGROUND PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT ABOUT KAISER PERMANENTE ABOUT KAISER PERMANENTE COMMUNITY BENEFIT KAISER PERMANENTE S APPROACH TO THE COMMUNITY HEALTH NEEDS ASSESSMENT About the new federal requirements SB 697 and California s history with past assessments Kaiser Permanente s CHNA framework and process III. COMMUNITY SERVED KAISER PERMANENTE S DEFINITION OF COMMUNITY SERVED BY HOSPITAL FACILITY DESCRIPTION AND MAP OF COMMUNITY SERVED BY KFH-PANORAMA CITY Geographic Description Socio-demographic Profile Access to Health Care Chronic Disease Prevalence and Incidence IV. WHO WAS INVOLVED IN THE ASSESSMENT V. PROCESS AND METHODS USED TO CONDUCT THE CHNA A. SECONDARY DATA B. COMMUNITY INPUT C. DATA LIMITATIONS AND INFORMATION GAPS VI. IDENTIFICATION AND PRIORITIZATION OF COMMUNITY S HEALTH NEEDS 60 A. IDENTIFYING COMMUNITY HEALTH NEEDS B. PROCESS AND CRITERIA USED FOR PRIORITIZATION OF THE HEALTH NEEDS C. PRIORITIZED DESCRIPTION OF COMMUNITY HEALTH NEEDS VII. COMMUNITY ASSETS AND RESOURCES AVAILABLE TO RESPOND TO THE IDENTIFIED HEALTH NEEDS OF THE COMMUNITY P a g e

6 APPENDIX A: HEALTH NEED PROFILES Health Need Profile: Access to Primary Care Health Need Profile: Asthma Health Need Profile: Breastfeeding Health Need Profile: Cardiovascular Disease Health Need Profile: Cervical Cancer Health Need Profile: Dental Health Services Health Need Profile: Diabetes Health Need Profile: Mental Health Health Need Profile: Obesity/Overweight for Adult and Youth Health Need Profile: Physical Environment/Transportation Health Need Profile: Poverty Rates Health Need Profile: Prenatal Care Health Need Profile: Unemployment Health Need Profile: Uninsured Population APPENDIX B: PRIMARY DATA COLLECTION TOOLS AND INSTRUMENTS APPENDIX C: COMMUNITY RESOURCES BY CATEGORY APPENDIX D: REFERENCES/BIBLIOGRAPHY P a g e

7 Glossary of Terms The following are definitions of key CHNA terms referenced in this report. In order to standardize the process across the Region and to ensure compliance with the ACA regulations a shared understanding of these terms is important. Age-adjusted Rate The incidence or mortality rate of a disease can depend on the age distribution of a community. Because chronic diseases and some cancers affect older adults disproportionately, a community with a higher number of older adults might have a higher mortality or incidence rate of some diseases than another community that may have younger people. An incidence or mortality rate that is ageadjusted takes into the consideration of the proportions of persons in corresponding age groups, which allows for more meaningful comparison between communities with different age distributions. Benchmarks 4 Something that serves as a standard by which others may be measured or judged (Example: Healthy People 2020). Community Assets Those people, places and relationships that can conceivably be used in acting to bring about the most equitable functioning of a community (Example: FQHC s, primary care physicians, parks). Community Health Needs Assessment 5 (CHNA) A systematic process involving the community to identify and analyze community health needs and assets. Community Served Based on ACA regulations, the community served is to be determined by each individual hospital. It is generally defined by a geographical location such as a city, county or metropolitan region. A community may also take into consideration certain hospital focus area (i.e., cancer, pediatrics) but should not be denied so narrowly as to intentionally exclude high needs groups such as the elderly or low income individuals. Disease Burden Disease burden refers to the impact of a health issue not only on the health of the individuals affected by it, but also the financial cost in addressing this health issue, such as public expenditures in addressing a health issue. The burden of disease can also refer to the disproportionate impact of a disease on certain populations, which may negatively affect their quality of life and socioeconomic status. 4 P a g e

8 Drivers of Health Risk factors are issues that may positively or negatively impact a health outcome. For the purposes of KP s CHNA they have been divided into four categories: social and economic factors, physical environment, health behaviors and clinical care access and delivery. Health Indicator 6 A characteristic of an individual, population, or environment which is subject to measurement (directly or indirectly) and can be used to described one or more aspects of health of an individual or population ( Examples: Percent of children overweight in Santa Clarita County, Incidence of breast cancer in Santa Clara County). Health Disparity Diseases and health problems do not affect all populations in the same way. Health disparity refers to the disproportionate impact of a disease or a health problem on specific populations. Much of research literature on health disparity focuses on racial and ethnic differences in how these communities experience the diseases, but health disparity can be correlated with gender, age, and other factors, such as veteran, disability, and housing status. Health Needs Health outcomes that are disproportionately impacting a particular population. They are identified through interpretation and analysis of secondary data as well as primary data. (Example: breast cancer, obesity and overweight, asthma) Health Outcomes 7 Health Outcomes are snapshots of diseases in a community that can be described in terms of both morbidity and mortality. They are measureable health indicators that may be used to identify and prioritize health needs. (Example: breast cancer prevalence, lung cancer mortality, homicide rate) Immediate Needs Immediate needs are health needs that the community felt needs an immediate intervention. Implementation Strategy 8 The non-profit hospital s plan for addressing the health needs identified through the community health assessment. (CHNA) Incidence 9 A measure of the occurrence of new disease in a population of people at risk for the disease, (Example: 1,000 new cases of breast cancer in 2011). 5 P a g e

9 Intermediate Needs Intermediate needs are the health needs that the community felt needs attention once the immediate needs have been addressed. Mortality Rate Mortality rate refers to the number of deaths in a population due to a disease. It is usually expressed as a density rate (e.g. x number of cases per 10,000 people). Prevalence 10 The proportion of total population that currently has a given disease (Example: 1,000 total cases of lung cancer in 2011). Primary Data New data that is collected or observed directly from first-hand experience; typically, primary data collected for CHNA is qualitative in nature. (Example: Focus groups, key informants interviews) Qualitative Data 11 Typically descriptive in nature and not numerical; however, it can be coded into numeric categories for analysis. Qualitative data is considered to be more subjective than quantitative data but describes what is important to people who provide the information. (Example: Focus group data) Quantitative Data 12 Data that has numeric value. Quantitative data is considered to be more objective than qualitative data. (Example: State or National survey data) Risk Factor 13 Characteristics (genetic, behavioral, and environmental exposures and sociocultural living conditions) that increase the probability that an individual will experience a disease (morbidity) or specific cause of death (mortality). Some risk factors can be changed (e.g., smoking) while others cannot (e.g., family history) Secondary Data Data that has already been collected and published by another party. Typically, secondary data collected for CHNA is quantitative in nature (Example: California Health Interview Survey (CHIS), Behavioral Risk Factor Surveillance System (BRFSS)) Source: 4 Merriam Webster Dictionary. Retrieved from 5 World Health Organization (WHO). Retrieved from 6 Health Promotion Glossary, World Health Organization, Division of Health Promotion, Education and Communications (HPR), Health Education and Health Promotion Unit (HEP), Geneva, Switzerland, P a g e

10 7 Catholic Health Association of the United States (March, 2011). Assessing & addressing community health needs: Discussion Draft. Retrieved from _Community_Health_Need.aspx 8 Ibid 9 Aschengrau, A. & Seage, G.R. (2008). Essentials of Epidemiology in Public Health. Sudbury, Massachusetts: Jones and Barlett Publishers. 10 Ibid. 11 Catholic Health Association of the United States (March, 2011). Assessing & addressing community health needs: Discussion Draft. Retrieved from _Community_Health_Need.aspx 12 Ibid 13 Adapted from: Green L. & Kreuter M. (2005). Health program planning: An educational and ecological approach. 4th edition. New York, NY: McGrawhill. 7 P a g e

11 I. Executive Summary Community Health Needs Assessment (CHNA) Background The Patient Protection and Affordable Care Act (ACA) enacted on March 23, 2010, added new requirements, which nonprofit hospital organizations must satisfy to maintain their tax-exempt status under section 501(c) 3 of the Internal Revenue Code. One such requirement added by ACA, 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, transparency and leveraging emerging technologies. The CHNA process undertaken in 2013 and described in this report is conducted in compliance with these new federal requirements. Summary of Needs Assessment Methodology and Process VCCC s overarching aim and main objective in creation of this report is to identify and prioritize unmet community health needs. More importantly this report will act as the foundation to create an implementation strategy to plan coordinated and potential collaborative efforts and activities to promote and improve the health of all individuals residing in the KFH - Panorama City Medical Center Service Area. The area consists of 3,668 sq. miles that spans two Service Planning Areas (SPA), SPA1 and SPA 2 that are distinctly different. The CHNA team collected data on common indicators from the Kaiser Permanente CHNA data platform which is being used by all of its regions. The national common indicators included data in the following categories: demographics, social and economic factors, health behaviors, physical environment, clinical care, and health outcomes. In addition the team utilized the Dignity Health s Community Need Index TM (CNI) to determine areas of highest need. The CNI aggregates socioeconomic indicators known to contribute to health disparity. Additional secondary data sources included The Nielson Company & Thomson Reuter s disease prevalence data at the zip code level to provide a comprehensive epidemiologically-based health profile of the area. The CHNA team also conducted local literature review. A data resource list can be located under Appendix D. Primary data are new data collected directly from first-hand experience. They are typically qualitative (not numerical) in nature. For this community health needs assessment, primary data were collected through key informant interviews, focus groups and community forums with community 8 P a g e

12 stakeholders. These primary data describe what is important to the people who provide the information and are useful in interpreting secondary data. Secondary data are data that have been collected and published by another entity. They are typically quantitative (numerical) in nature. Secondary data are helpful in highlighting in an objective manner health outcomes that significantly impact a community. Between September and December 2012, 5 focus groups and 8 community forums were conducted in various settings throughout the region. There were 17 key informant interviews conducted with social service, health, public health and clinic service providers. Additionally, 346 surveys were collected and analyzed for common themes. Secondary data was reviewed for validity and appropriateness. The numeric values were then benchmarked against the state, national and HP 2020 targets. Health and socio-economic related issues not meeting benchmarks were compiled into a list of identified health needs. Feedback collected from primary data collection was then used to determine if community perception of health needs aligned with the secondary data. Following the identification of health needs, the CHNA team brought together health care experts and community residents to prioritize the list into 10 most immediate health needs for KFH- Panorama City Medical Center Service Area. A total of two meetings were conducted: one in Panorama City and one in Antelope Valley. Those that participated in prioritization received a copy of the health need profiles created for the identified health needs. Through a multi-voting approach the participants were asked to reach a consensus on the most immediate needs. In addition to the health need profiles the following main criteria were considered during the prioritization process: 1. Does the issue impact both the Antelope Valley and Panorama City? 2. How severe is the problem (i.e. meeting benchmarks state, nation or Healthy People)? 3. Is the issue getting worse over time? 4. Has the community ranked the issue over other issues? 5. Are there reasonable resolutions to the problems? Please note that the KFH Panorama City Medical Center Service Area is split into two distinct areas; one is listed as Panorama City and the other as Antelope Valley. Because both areas are unique, issues that are an immediate need in one area may not have been ranked a priority in the other area. In fact, Panorama City and Antelope Valley s individual top 10 immediate needs did differ as you will see in Section V of this report. The prioritized list for the entire medical center service area was calculated by tabulation of individual rankings from individuals completing the ranking via an online survey. Please note that the KFH Panorama City Medical Center Service Area is split into two distinct areas; one is listed as Panorama City and the other as Antelope Valley. Because both areas are unique, issues that are an immediate need in one area may not have been ranked a priority in the other area. In fact, Panorama City and Antelope Valley s individual top 10 immediate needs did differ as 9 P a g e

13 you will see in Section V of this report. The prioritized list for the entire medical center service area was calculated by tabulation of individual rankings from individuals completing the ranking via an online survey. Summary of Prioritized Needs The 10 most immediate and significant health needs that rose to the top for the KFH - Panorama City Medical Center Service Area based on prioritization process are listed below (from highest to lowest priority): 1. Access to Primary Care 2. Obesity/Overweight for Adult and Youth 3. Mental Health 4. Dental Health Services 5. Uninsured Population 6. Physical Environment/Transportation 7. Poverty Rates 8. Diabetes 9. Prenatal Care 10. Breastfeeding The health of the community is the result of many inter-related factors. A key concern for a majority of the community residents and some of the experts has been the impact on the community due to poor economy, unemployment, reduced hours, reduced pay, and in many instances the loss of employer based health care. The overall consensus was that many issues such as obesity, chronic disease, and depression could be the result of stress that comes from being part of the working poor population. The following information provides a summary for each of the prioritized health needs. Data in the following descriptions was retrieved from the CHNA data platform, L.A. Department of Public Health, and The Nielson Company, Thomson Reuters, 2012 unless otherwise noted. Access to Primary Care - Over 55% of respondents identified access to primary care as an immediate need. There are 20 Federally Qualified Health Centers (FQHC) located in the 3,668 square miles that make up the KFH-Panorama City Medical Center Service Area. However 15 of the FQHC s are located in the Panorama City area (856 sq. miles) and 5 FQHC s are located in the Antelope Valley area (2,812 sq. miles). Limited English Proficiency also poses a barrier to healthcare services. This is especially relevant in Panorama City where 26.74% of the population speak English less than very well and speak another language at home. This issue is not as relevant in the Antelope Valley (14.47%) which brings the area average to 23.53% which fares worse than the state (19.85%) and the nation (8.70%). Additionally the high volume of preventable hospitals events in the Antelope Valley ( per 10,000 population compared to Panorama City (105.73) and California (83.17)) shows a need for 10 P a g e

14 improved disease management. Preventable hospital events include diabetes and other events that could have been prevented if there were adequate primary care resources. Obesity/Overweight for Adult and Youth The 2012 Los Angeles County Department of Public Health article on Trends in Obesity: Adult Obesity Continues to Rise states that Over the past decade, the obesity epidemic has emerged as one of the most significant public health threats in Los Angeles County and across the nation. The report went on to state obesity is an issue with youth as well. A large majority of those that participated in focus groups and community forums felt obesity is a major health issue. Adults and youth living in low-income minority communities are at a higher risk for obesity and overweight with greater risk of developing chronic disease. In KFH Panorama City Medical Center Service Area, the percentage of obese children (33.75%) is higher than the state (29.82%) and is not meeting the benchmark. Mental Health - Mental health issues inclusive of dual diagnosis (mental health with substance abuse and/or mental health with chronic disease) were a topic of discussion in many of the community forums and focus groups. According to 2012 Thomson Reuter s Depression/Anxiety Estimates for KFH Panorama City Medical Center Service Area, 135,961 cases or 8.5% of the population is dealing with depression or anxiety. The majority of the estimated cases affect those adults 18 to 64 years of age. Major depression has been linked to higher suicide rates which is a huge problem in Antelope Valley (12.4 Per 100,000 Population). The Antelope Valley rate is much higher than Panorama City (7.4 Per 100,000 Population) which creates an average 8.7 per 100,000 population rate for the entire KFH Panorama City Medical Center Service Area. While the area overall falls within California (9.79 Per 100,000 Population) rates, and Healthy People 2020 goal of 10.2 per 100,000 Pop, when looking at each of the two areas there is a noticeable problem in the Antelope Valley. A key informant shared that There is no real infrastructure for adult mental health. Resources and services in our area are very sparse. Dental Health Services - Adults who self-reported having poor dental health in KFH Panorama City Medical Center Service Area (11.66%) faring slightly worse than California (11.27%). Stakeholders shared that the problem is worse for seniors because Medicare does not provide coverage for preventative (cleaning and x-rays) care. In addition, Medi-Cal stopped providing Denti- Cal for adults while retaining services for children. A major concern is the high percentage of adults (34.65%) who self-report they have not visited a dental professional in the past year is worse than the state average of (30.51%). In addition, 12.22% of teens have not had a dental visit in the past year again faring worse than the state average (10.07%). These numbers are in alignment with the numbers of adults without dental insurance in the area (37.36%) which is also worse than the state (33.72%). Many stakeholders were concerned that people underestimate how vital good dental health is to a person s overall general health. Uninsured Population - The lack of health insurance is considered a key driver of health status. KFH Panorama City Medical Center Service Area stakeholders felt it should be addressed as an immediate need. While many felt that the Patient Protection Affordable Care Act (ACA) will help to reduce the burden of uninsured in 2014, concerns remain high especially in the Panorama City area 11 P a g e

15 where the majority of the population is Latino. A percentage of this population may be undocumented and ineligible for ACA coverage. In KFH Panorama City Medical Center Service Area, Panorama City (22.37%) has the higher percentage of uninsured population compared to Antelope Valley (16.47%). However, the overall KFH - Panorama City Medical Center Service Area (20.81%) is not meeting the state (17.92%) or the U.S. (15.05%) benchmark. Physical Environment/Transportation - Stakeholders brought up the physical environment in both Panorama City and Antelope Valley areas. Community members brought up issues such as public safety, access to parks, and green space. Another major concern that was often brought up by the community was transportation. Transportation as a barrier to accessing health care services was noted to affect the low-income, homeless, chronically ill, disabled and senior population more adversely then others. One key informant shared Primarily in this area, it s the distances between residential areas and key health services. In the Antelope Valley and Palmdale most of the health services are located in the same area. Some folks who live in areas such as Lake Los Angeles, Acton, and Little Rock face the greatest transportation barriers. Poverty Rates - The KFH Panorama City Medical Center Service Area with 15.04% of population living below 100% Federal Poverty Level (FPL) exceeds the state percentage of 13.71%. The Antelope Valley in KFH Panorama City Medical Center Service Area is higher (18.68%) compared to Panorama City (13.74%). Diabetes - Nationally there is an increase in the incidence of Type II Diabetes in both adults and youth. This has been directly associated with the rising rates of overweight and obesity in the United States. Diabetes prevalence rate in the overall KFH Panorama City Medical Center Service Area (7.71%) is slightly higher than the state (7.57%). Antelope Valley is slightly higher (7.73%) than Panorama City (7.70%). This indicator represents the percentage of the population over 20 years old that have been told by a doctor they have diabetes. It is interesting to note that while the prevalence of diabetes is only slightly higher than the state, the rate of diabetes hospitalizations and deaths in the area especially Antelope Valley is extremely high. Prenatal Care - There is grave disparities in the KFH Panorama City Medical Center Service Area between the Antelope Valley and Panorama City related to prenatal care. The percentage of mothers with late or no prenatal care in the Antelope Valley (32.05%), Panorama City (10.75%) and the combined area rate of (16.84%) is much higher than the state (3.14%). This indicator highlights a lack of access to primary care and health knowledge. Lack of prenatal care can also lead to low birth weight infants. Breastfeeding - Greater emphasis and legislation has been put forth on the importance of breastfeeding to improve the health of infants. Research shows that breastfeeding can lead to reduced rates of childhood obesity. The combined rate of exclusive breastfeeding in KFH Panorama City Medical Center Service Area (46.98%) is much lower than the state (60.63%). With similar low rates of breastfeeding in Antelope Valley (46.88%) and Panorama City (47.02%), both areas are not meeting the state (60.63%) benchmark. 12 P a g e

16 II. Introduction/Background Purpose of the Community Health Needs Assessment Report Kaiser Permanente is dedicated to enhancing the health of the communities it serves. The findings from this CHNA report will serve as a foundation for understanding the health needs found in the community and will help with forming the Implementation Strategy for Kaiser Foundation Hospitals as part of their Community Benefit planning. This report complies 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 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 regarding conducting the CHNA for the hospital facility. 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 9 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. 13 P a g e

17 About Kaiser Permanente Community Benefit 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 Health, requires equity and social and economic well-being. Like our approach to medicine, our work in the community takes a prevention-focused, evidencebased 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. 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 Community Health Needs Assessments 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 the Community Health Needs Assessment About the new federal requirements Federal requirements included in the ACA, 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 ACA 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 (SB 697), which requires all private nonprofit hospitals in the state to conduct a CHNA every three 14 P a g e

18 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 web-based CHNA data platform to facilitate implementation of the CHNA process. More information about the CHNA platform can be found at Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. 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 15 P a g e

19 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 Kaiser Permanente 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 the community health needs were identified, they were 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 examine the list of prioritized health needs and develop an implementation strategy for those health needs it will address. These strategies will build on Kaiser Permanente s assets and resources, as well as evidence-based strategies, wherever possible. The Implementation Strategy will be filed with the Internal Revenue Service using Form 990 Schedule H. III. Community Served Kaiser Permanente s definition of community served by hospital facility 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. Description and map of community served by KFH-Panorama City KFH - Panorama City Medical Center serves the communities of the East San Fernando Valley, Santa Clarita Valley, and Antelope Valley, as depicted in the map below. Although many residents of the Antelope Valley seek hospital services from closer community hospitals, KFH - Panorama City Medical Center Service Area includes the Antelope Valley service area in the "community" for purposes of this CHNA because KFH - Panorama City Medical Center is part of an integrated delivery system that serves this broader area. This broader area will be referred to as the KHF - Panorama City Medical Center Service Area for purposes of this report. The broad communities served by KFH - Panorama City Medical Center Service Area have diverse geography, topography and vary across levels of socio-economic status. As such, in addition to information about the health 16 P a g e

20 needs of the broader KFH - Panorama City Medical Center Service Area, this report will also include information about Panorama City and Antelope Valley service areas separately to capture both the commonalities and well as the unique problems that exists across these geographies. This will enhance understanding of the significant health needs of KFH - Panorama City Medical Center communities to form more targeted implementation strategies. KFH - Panorama City Medical Center Service Area has two very uniquely characterized areas; Panorama City and the Antelope Valley with diverse geography, topography and large geographic land area with varied levels of socioeconomic status. The residents in the KFH Panorama City Medical Center Service Area share some commonalities and some very unique problems that exist in their individual communities. 17 P a g e

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22 Geographic Description The KFH Panorama City Medical Center Service Area includes the San Fernando, Santa Clarita, and Antelope Valleys. The San Fernando Valley includes Arleta, Granada Hills, Lakeview Terrace, Mission Hills, North Hills, North Hollywood, Northridge, Pacoima, Panorama City, San Fernando, Sepulveda, Sherman Oaks, Studio City, Sunland, Sun Valley, Sylmar, Toluca Lake, Tujunga, Universal City, Valley Village, and Van Nuys. The Santa Clarita Valley includes Canyon Country, Castaic, Newhall, Santa Clarita, Saugus, Stevenson Ranch, Val Verde, and Valencia. The Antelope Valley includes Acton, California City, Lake Hughes, Lancaster, Littlerock, Llano, Mojave, Palmdale, Pearblossom, Rosamond and Valyermo. The following table summarizes the KFH- Panorama City Medical Center Service Area: Communities of KFH - Panorama City Medical Center Service Area City/Community Zip Codes County Acton Los Angeles, SPA 1 California City Kern Cantil, Mojave Kern Canyon Country 91351, Los Angeles, SPA 2 Castaic, Val Verde Los Angeles, SPA 2 Granada Hills Los Angeles, SPA 2 Lake Hughes Los Angeles, SPA 1 Lancaster 93534, 93535, Los Angeles, SPA 1 Littlerock Los Angeles, SPA 1 Llano Los Angeles, SPA 1 Mission Hills Los Angeles, SPA 2 Mojave Kern Newhall Los Angeles, SPA 2 North Hills, Northridge, Sepulveda Los Angeles, SPA 2 North Hollywood, Studio City, Toluca Lake 91601, 91602, 91605, Los Angeles, SPA 2 Pacoima, Arleta, Lakeview Terrace Los Angeles, SPA 2 Palmdale 93552, 93550, 93551, Los Angeles, SPA 1 Panorama City Los Angeles, SPA 2 Pearblossom Los Angeles, SPA 1 Rosamond Kern San Fernando Los Angeles, SPA 2 Santa Clarita, Saugus 91350, Los Angeles, SPA 2 Sherman Oaks Los Angeles, SPA 2 Stevenson Ranch Los Angeles, SPA 2 Studio City Los Angeles, SPA 2 Sun Valley Los Angeles, SPA 2 Sunland Los Angeles, SPA 2 Sylmar Los Angeles, SPA 2 19 P a g e

23 Tujunga Los Angeles, SPA 2 Valencia, Santa Clarita 91354, Los Angeles, SPA 2 Valley Village Los Angeles, SPA 2 Valyermo Los Angeles, SPA 1 Van Nuys 91401, 91405, Los Angeles, SPA 2 Universal City Los Angeles, SPA 2 Source: Health Cities Socio-demographic Profile Population In the KFH - Panorama City Medical Center Service Area, Panorama City area is more densely populated with 1,126,736 people living in Sq. miles compared to Antelope Valley with 403,158 people living in 2, Sq. miles. Overall, KFH - Panorama City Medical Center Service Area is more densely populated compared to the state of California and the U.S. High population density could possibly contribute to more communicable health issues. Table 1: Total Population Density Report Area Total Population Total Land Area (Square Miles) Population Density (Per Square Mile) KFH - Panorama City Medical 1,529,894 3, Center Service Area Antelope Valley (Service Area) 403,158 2, Panorama City (Service Area) 1,126, ,317 Los Angeles County 9,758,256 4, , California 36,637, , United States 303,965,271 3,531, Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract. Population by Gender Table 2: Population by Gender Report Area Male Female % Male % Female KFH - Panorama City Medical 765, , % 49.99% Center Service Area Antelope Valley (Service Area) 200, , % 50.35% Panorama City (Service Area) 564, , % 49.86% Los Angeles County 4,811,964 4,946, % 50.69% California 18,223,156 18,414, % 50.26% United States 149,398, ,566, % 50.85% Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract. The total population of KFH - Panorama City Medical Center Service Area (1,529,893) is equally distributed with 49.99% females and 50.01% males. 20 P a g e

24 Percentages Population by Ethnicity Los Angeles County includes socially, culturally and economically diverse populations. KFH - Panorama City Medical Center Service Area is home to multi-ethnic, multi-lingual populations that require health care services that are innovative and culturally appropriate. The ethnic distribution of the population in KFH Panorama City Medical Center Service Area is Hispanics (49.50%), followed by White (33.81%), Asians (7.36%) and Blacks (6.65%). A total of (2.68%) of the population falls under multiple and other races which could include smaller groups of people from various ethnic backgrounds. Graph 1: Population by Ethnicity KFH Panorama City Medical Center Service Area Lancaster Palmdale Van Nuys Pacoima Sylmar Panorama City White % Black % Asian % Hispanic % All Other % Data Source: The Nielsen Company., Thomson Reuters, 2012 The six most populated cities in KFH - Panorama City Medical Center Service Area are Lancaster (186,865), followed by Palmdale (176,204), Van Nuys (167,511), Pacoima (103,747), and Sylmar (93,100) and Panorama City (69,925). Of the most densely populated cities Pacoima has the highest percent of Hispanic population (88.46%) compared to other cities in KFH - Panorama City Medical Center Service Area (2012 The Nielsen Company, 2012 Thomson Reuters). Population by Age Graph 2: Population by Age Distribution 9% 7% 9% 19% 14% 10% 16% 16% Age 0-4 Age 5-17 Age Age Age Age Age Age 65+ Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract. 21 P a g e

25 About 26% of the total population in KFH - Panorama City Medical Center Service Area is children and youth between the ages of 0-17 years; 65% are adults between the ages of 18 to 64 years and 9% are older adults ages 65 plus. In general, older population use more health care services compared to younger population. Table 3: Population Change between 2000 and 2010 U.S. Census Report Area Total Population, 2010 Census Total Population, 2000 Census Percent Change from Census KFH - Panorama City Medical 1,573,307 1,518, % Center Service Area Antelope Valley (Service Area) 420, , % Panorama City (Service Area) 1,152,704 1,117, % Los Angeles County 9,818,605 9,519, % California 37,253,956 33,871, % United States 308,745, ,421, % Note: No breakout data available. Data Source: U.S. Census Bureau, 2000 Census of Population and Housing, Summary File 1; U.S. Census Bureau, 2010 Census of Population and Housing, Summary File 1. Source geography: County. The percentage of growth in Antelope Valley (4.95%) exceeded Panorama City (3.14%). Overall growth in KFH - Panorama City Medical Center Service Area between 2000 and 2010 was 3.62%. A positive or negative shift in the total population over time impacts health care providers, and the utilization of health care services and resources. Limited English Proficiency The inability to speak English can create barriers to healthcare access, provider communications, and health literacy/education. KFH - Panorama City Medical Center Service Area has a higher percent (23.53%) of population that has limited English proficiency compared to the state (19.85%) and the U.S. (8.70%). Antelope Valley (14.47%) is lower than the state and the U.S benchmarks; however, Panorama City (26.74%) and the L.A. County (26.97%) have a higher percentage of people not speaking English proficiently and therefore not meeting the state and the national benchmarks. This could likely be due to the higher percentages of Latino, Asian and other multiple ethnicities in KFH Panorama City Medical Center Service Area speaking a language other than English at home. The Nielson Company and Thomson Reuters report estimates that communities such as Pacoima (80%), San Fernando (77.8%), and Panorama City (66.6%) have the highest monolingual Spanish population in KFH - Panorama City Medical Center Service Area. Community feedback from focus groups, community forums, and key informant interviews identified language as one of the major barriers for not seeking or acquiring appropriate medical care. Lack of effective communication between health care providers and community members increases the probability of patient noncompliance with prescribed treatment and pharmaceuticals, which could negatively affect the health outcomes. Language was also identified as a contributing factor for the 22 P a g e

26 lack of health literacy, understanding the importance of seeking preventative services and lack of awareness regarding the available health care resources in the community. Table 4: Percent of Population With Limited English Proficiency Report Area Total Population (For Whom English Proficiency is Determined) Total Limited English Proficiency Population KFH - Panorama City Medical Percent Limited English Proficiency Population 1,419, , % Center Service Area Antelope Valley (Service Area) 371,609 53, % Panorama City (Service Area) 1,048, , % Los Angeles County 9,098,454 2,453, % California 34,092,224 6,768, % United States 283,833,856 24,704, % Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract. Poverty <100% Federal Poverty Level (FPL) Poverty is a key driver of health status in a community. Those living at <100% of the FPL in KFH - Panorama City Medical Center Service Area (15.04%) is not meeting the state (13.71%) and the national (13.82%) benchmarks. Within the KFH Panorama City Medical Center Service Area, poverty in Antelope Valley (18.68%) is significantly higher than in Panorama City (13.74%). Poverty creates barriers for accessing health services, healthy food, and other necessities and contributes to poor health status. Poverty could likely contribute to the high rates of people not graduating from high school and unemployment rates. The communities with the highest number of households with an annual income less than $15,000 in KFH - Panorama City Medical Center Service Area are Palmdale, Lancaster, North Hollywood, Van Nuys, Mojave, and Acton. The communities with less than 5,000 residents such as Pearblossom, Llano, Cantil, and Mojave have disproportionately distributed annual income levels resulting in many residents with an annual income less than $15,000 (The Nielsen Company., Thomson Reuters, 2012). 23 P a g e

27 Table 5: Population in Poverty (<100%FPL) Report Area Total Population (For Whom Poverty Status is Determined) Total Population in Poverty (<100% FPL) Percent Population in Poverty (<100% FPL) KFH - Panorama City Medical Center 1,503, , % Service Area Antelope Valley (Service Area) 395,118 73, % Panorama City (Service Area) 1,108, , % California 35,877,036 4,919, % United States 296,141,152 40,917, % Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract. Population Below 200%FPL Population below 200% FPL is affected by many of the same barriers of people under 100% FPL. Poverty has been identified as a barrier to accessing healthy foods, health care, dental care and other services that are necessities to lead a healthier life. The percent of population with income below 200% FPL is high in KFH - Panorama City Medical Center Service Area (36.86%) compared to the state (32.83%) and the U.S. (31.98%). Therefore, KFH - Panorama City Medical Center Service Area is not meeting either the state or the national benchmarks. Table 6: Population with Income Below 200% Poverty Level Report Area Total Population Population with (For Whom Income Below 200% Poverty Status is Poverty Level Determined) KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) Percent Population with Income Below 200% Poverty Level 1,503, , % 395, , % 1,108, , % California 35,877,036 11,779, % United States 296,141,152 94,693, % Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract The communities such as Lancaster, Palmdale, North Hollywood, and Van Nuys have the highest number of households that fall under the 200% poverty level in KFH - Panorama City Medical Center Service Area (The Nielsen Company and Thomson Reuters, 2012). 24 P a g e

28 Children in Poverty Children between 0 and 17 years of age who live below 100% FPL face greater barriers then adults. Research shows that hunger affects learning and behavior. Poverty impacts the parent s ability to access health services, affordable housing, and healthy food along with other necessary life sustaining services that impacts the overall health of a child. Table 7: Percent of Children in Poverty Report Area Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract. The KFH - Panorama City Medical Center Service Area has 21.33% of children in their area living in poverty; this percent is higher than the state (19.06%) and the U.S. (19.19%) benchmarks. The percent of children living in poverty is significantly higher in Antelope Valley (26.77%) compared to Panorama City (19.86%). Figure 1: Percent of Children in Poverty Total Population (For Whom Poverty Status is Determined) Children in Poverty Percent Children in Poverty KFH - Panorama City Medical 413,280 88, % Center Service Area Antelope Valley (Service Area) 125,609 33, % Panorama City (Service Area) 287,671 54, % California 9,173,776 1,748, % United States 72,850,296 13,980, % Percentage of Children (Age 0-17), by Tract, ACS Year Estimate Over 40.0% % % 10.1% % Under 10.1% 25 P a g e

29 Unemployment Rate Table 8: Unemployment Rate (Per 100,000 Populations) Report Area Labor Force Number Employed Number Unemployed Unemployment Rate KFH - Panorama City 787, ,250 81, Medical Center Service Area Antelope Valley (Service 209, ,577 22, Area) Panorama City (Service Area) 578, ,673 59, California 18,648,310 16,835,907 1,812, United States 1,065,164, ,901,418 86,262, Note: This indicator is compared with the state average. Data Source: U.S. Bureau of Labor Statistics, December, 2012 Local Area Unemployment Statistics. Source geography: County. In KFH - Panorama City Medical Center Service Area, Antelope Valley has a higher unemployment rate (10.56) compared to Panorama City (10.28). As a whole, the KFH Panorama City Medical Center Service Area (10.35) is higher than the state (9.70) and the U.S (8.10). Increased unemployment rates could lead to an increase in the number people living below 200%FPL. Population without High School Diploma Percentage of the population with no high school diploma is higher in KFH Panorama City Medical Center Area (23.77%) compared to the state (19.32%) and the U.S. (14.97%). Within KFH - Panorama City Medical Center Area, Panorama City has the highest percentage (24.25%) of people without high a school diploma compared to Antelope Valley (22.30%). Pacoima (33%), San Fernando (29.0%), Panorama City (25.5%), Sun Valley (23.1%) and North Hollywood (24.3%) are specific communities in the KFH- Panorama City Medical Service Area that have more than 20% of the population over age 25 with less than a 9 th grade education (U.S. Census Bureau, American Community Survey). Graph 3: Percent of Population without High School Diploma 23.77% 22.30% 24.25% 19.32% 14.97% PFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract. 26 P a g e

30 High School Graduation Rate On time graduation rates are lower in the KFH - Panorama City Medical Center Service Area. Panorama City (75.93%) and Antelope Valley (79.48%) compared to the state (82.27%) and the U.S. (82.26%). In addition to faring worse than the state and nation they are not meeting the HP 2020 Target (>82.4%). Community leaders and agency partners who participated in key informant interviews and focus groups expressed concern about the literacy levels of the community and felt that the cycle of poverty will continue without the knowledge to obtain higher paying jobs. Table 9: Percent of Students Graduating on Time Report Area Total Student Enrollment Average Freshman Base Enrollment Diplomas Issued On-Time Graduation Rate KFH - Panorama City Medical 87,191 21,663 16, Center Service Area Antelope Valley (Service Area) 28,388 5,342 4, Panorama City (Service Area) 58,803 16,321 12, California 1,971, , , United States 14,815,258 3,745,141 3,080, HP 2020 Target >82.4 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: U.S. Department of Education, National Center for Education Statistics (NCES), Common Core of Data, Local Education Agency (School District) Universe Survey Dropout and Completion Data, Source geography: School District. Community leaders shared their concerns regarding lack of English and language proficiency, math skills, and high school dropout rates, stating these reflect negatively on the wellbeing and growth of the communities they live in. Students Reading below 4 th Grade Level Graph 4: Percent of Students Reading below 4 th Grade Level 40.54% 47.72% 37.22% 35.64% 28.63% 36.30% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States HP 2020 Target 27 P a g e

31 The overall percentage of students reading below the 4 th grade level in KFH Panorama City Medical Center Service Area is much higher (40.54%) compared to the state (35.64%), the U.S (28.63%) and the HP 2020 target rate of <=36.3%. KFH Panorama City Medical Center Service Area, Antelope Valley s percentage (47.72%) is higher compared to Panorama City s percentage (37.22%). This issue was identified as a high level of concern in the community by the community leaders, educators and stakeholders during the primary data collection process. Low literacy levels were identified as possible reasons for rates of unemployment, poverty, and poor general health. Respondents also noted that the low literacy levels of residents of the community created barriers to health education and the reading of distributed printed materials. Figure 2: Percent of Students reading below 4 th Grade Level Pct. of Student Test Scores 'Not Proficient', By School District, State Department of Education, 2011 Over 45.0% % % % Under 15.1% The inability to read English is linked to poverty; unemployment; and barriers to healthcare access, provider communication and health literacy. Homeless Populations Los Angeles Homeless Services Authority (LAHSA) defines chronic homelessness as An unaccompanied disabled person who has been continuously homeless for over one year or has had at least four episodes of homelessness in three years; or a family is considered chronically homeless if at least one member meets the definition of chronic homelessness (LAHSA, 2011). More than 60% of the chronically homeless population falls between 25 and 54 years of age. The 2013 Key Indicators of Health report published by the Los Angeles County Department of Public Health, reports that Antelope Valley has the highest percent (28.0%) of adults who were unable to pay their rent or mortgage in the past 2 years. Key Indicator also reports that SPA 2 (San Fernando and Santa Clarita Valleys) in LA County has the highest percent of (9.6%) homeless adults compared to the rest of the SPAs in the County (Los Angeles County Department of Public Health, Office of Assessment and Epidemiology (Key Indicators of Health by Service Planning Area, March 2013). 28 P a g e

32 Community Safety Table 10: Community Safety by SPAs Neighborhood LA County SPA 1 SPA 2 Percent of adults believe their neighborhood is safe 84.3% 87.1% 85.1% Children 1 to 17 years who can easily find a safe place to 84.2% 86.4% 87.5% play Adults who report little or no graffiti 69.2% 84.6% 74.2% Adults reporting little or no trash 76.1% 70.5% 81.9% Adults reporting adequate lighting on the street and around 79.2% 72.9% 71.1% their neighborhood Adults who report that sidewalks are well maintained in their neighborhood 80.4% 90.8% 79.5% Source: Key Indicators of Health by Service Planning Area (LAC DPH, 2013). Please note that the information presented is only at the county and SPA level. While KFH- Panorama City covers all of SPA 1, they only cover a portion of SPA 2. The findings from the primary data collection inform us differently. Many of the community residents expressed that they do not feel safe going out in their neighborhoods to play, walk or conduct physical activity due to crime, inadequate street lighting, and sidewalks in disrepair and gang violence. Community safety was a priority to the residents versus available access to health care services. Access to Health Care Uninsured Population Populations that do not have access to health insurance experience barriers to primary, specialty, dental, and mental health care. KFH - Panorama City Medical Center Service Area has higher rates of uninsured (20.81%) compared to the state (17.92%) and the nation (15.05%) benchmarks. Additionally, both Antelope Valley (16.47%) and Panorama City (22.37%) are higher than compared to the national benchmark. The communities in KFH - Panorama City Medical Center Service Area with the highest number of uninsured include Van Nuys, Lancaster, Palmdale, North Hollywood, Pacoima and Panorama City, Sylmar, North Hills, and Sun Valley. Being uninsured is a major factor in health care disparities. 29 P a g e

33 Graph 5: Percentage of Uninsured Population 20.81% 16.47% 22.37% 17.92% 15.05% KFH - Panorama City Med Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, American Community Survey 3-Year Estimates. Source geography: PUMA. Lack of Access to Primary Care One of the issues that surfaced from the feedback received from key informant interviews, community forums, and focus groups was the overwhelming consensus that there is lack of access to primary care for the under insured, uninsured and Medi-Cal patient. Over 55% of the respondents identified lack of access to primary care as the most immediate health need. In addition to having a high volume of uninsured there is also a lack of primary care health professionals. Many times this results in residents not having a consistent source for primary care which then leads to poorer health outcomes and greater cost to the health care system. All of these critical issues relate to an increase in the burden of diseases in communities. The primary care provider rates for KFH - Panorama City Medical Center Service Area (80.60 and per 100,000 population) are higher than the state (83.20) and the nation (84.70) and not meeting the benchmarks. Similarly, the percentage of people without a regular doctor in the KFH - Panorama City Medical Center Service Area (Panorama City 16.17% and Antelope Valley 16.70%) is higher and not meeting the state 14.23% benchmark. Table 11: Primary Care Provider Rate (Per 100,000 Population) Report Area Total Population Total Primary Care Providers Primary Care Provider Rate (Per 100,000 Population) KFH - Panorama City Medical 1,573,306 1, Center Service Area Antelope Valley (Service Area) 420, Panorama City (Service Area) 1,152, California 37,253,956 31, United States 312,471, , Note: This indicator is compared with the state average. Data Source: U.S. Health Resources and Services Administration Area Resource File, Source geography: County. 30 P a g e

34 Table 12: Lack of Access to Primary Care Report Area Sample Number Percent Population (Total) Without Regular Doctor Without Regular Doctor KFH - Panorama City Medical 1,625, , % Center Service Area Antelope Valley (Service Area) 432,105 72, % Panorama City (Service Area) 1,193, , % California 37,362,000 5,318, % Note: This indicator is compared with the state average. Data Source: California Health Interview Survey (CHIS), Source geography: County (Grouping). Percent of Designated Population Underserved Health care facilities designated as "Health Professional Shortage Areas" (HPSAs) are defined as having shortages of primary medical care, dental or mental health providers. This indicator is relevant because a shortage of health professionals contributes to access and health status issues. The following table reports the percentage of the population that is designated as underserved. Even though 67.86% of population is designated as underserved in KFH - Panorama City Medical Center Service Area, 90.68% of those people live in Antelope Valley. Table 13: Percent of Designated Population Underserved Report Area Total Population, 2010Census HPSA Designation Population Underserved Population Percent of Designated Population Underserved KFH - Panorama City 1,574, , , % Medical Center Service Area Antelope Valley 421,691 42,171 38, % (Service Area) Panorama City (Service 1,152, ,324 84, % Area) California 37,267,509 5,171, ,955, % United States 312,676,557 52,826, ,117, % Data Source: U.S. Health Resources and Services Administration, Health Professional Shortage Area File, Source geography: Address. The issue of physician shortage was brought up by the community residents, leaders and key informants during the primary data collection process. Shortage of mental health professionals was identified as the one of the top 5 needs in the Antelope Valley. KFH - Panorama City Medical Center Service Area is not meeting the state or the national benchmarks. 31 P a g e

35 Lack of Social Support The percentage of people who reported receiving some social support most of the time in KFH Panorama City Medical Center Service Area (71.19%) is lower than the state (75%) and the national (80.33%) benchmarks. These lower rates of social support were reiterated by the community members. About 18% of the 600 participants that contributed to the primary data reported that lack of family or social support is a contributing factor for their concerns regarding teen pregnancies, suicides, drug and alcohol abuse, overweight, and mental health issues in their communities. Graph 5: Population that Reported Inadequate Social Support 80.33% 71.19% 71.34% 71.13% 75% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Source geography: County. Infant Mortality The number of deaths of infants less than a year old per 1,000 births indicates the rates of infant mortality are connected to the issues pertaining to limited access to care. This could be representative of the prenatal care a mother receives, the birth weight of the babies and whether or not the babies receive breast milk. Participants of the primary data collection process identified infant mortality to be a concern in KFH - Panorama City Medical Center Service Area. The two major issues identified as contributing to the infant mortality were low birth weight and minimal prenatal care received by expectant mothers. During the primary data collection process, leaders, public health educators, service providers and stakeholders identified black infant mortality to be high in the Antelope Valley. This need did not rise to the top 10 immediate needs for Antelope Valley. Infant low birth weight and low breast feeding rate were ranked among the top 25 needs in Antelope Valley. Infant Low Birth Weight Birth weight under 2500g is categorized as low birth weight. This indicator is relevant because low birth weight infants are at high risk for health problems. This indicator can also highlight the existence of health disparities. The percent of low birth weight in KFH - Panorama City Medical 32 P a g e

36 Center Service Area (7.43%) is higher compared to the state (6.80%). Antelope Valley has a higher percent of low birth weights (8.98%) compared to Panorama City (6.81%). Table 14: Percent of Low Birth Weight Births Report Area Total Population Total Live Births Number Low Birth weight (1500g g) Number Very Low Birth weight (Under 1500g) Total Low Birth Weight Births Percent Low Birth Weight Births KFH - 1,571,942 21,826 1, , % Panorama City Medical Center Service Area Antelope Valley 419,491 6, % (Service Area) Panorama City 1,152,451 15, , % (Service Area) California 37,253, ,979 no data no data 34, % Note: This indicator is compared with the state average. Data Source: California Department of Public Health, Birth Profiles by ZIP Code, Source geography: ZIP Code. Breastfeeding In KFH Panorama City Medical Center Service Area, the percentage of mothers who breastfeed exclusively (46.98%) is considerably lower than the state (60.63%). Similarly, percentage of mothers who breastfeed any (90.77%) is lower than the state (91.74%). The community members identified low rates of breastfeeding to be a health concern and suggested increasing lactation education in the KFH - Panorama City Medical Center Service Area to increase overall rates of breastfeeding. Table 15: Percent of Mothers Breastfeeding (Exclusively or Any) Report Area Total In- Hospital Births Mothers Breastfeeding (Exclusively) Percent Mothers Breastfeeding (Exclusively) Mothers Breastfeeding (Any) Note: This indicator is compared with the state average. Data Source: California Department of Public Health, In-Hospital Breastfeeding Initiation Data, Source geography: County. Percent Mothers Breastfeeding (Any) KFH - 18,679 8, % 16, % Panorama City Medical Center Service Area Antelope Valley 5,077 2, % 4, % (Service Area) Panorama City 13,602 6, % 12, % (Service Area) California 873, , % 801, % 33 P a g e

37 Prenatal Care Overall, KFH - Panorama City Medical Center Service Area has a higher percentage of mothers receiving late or no prenatal care (16.84%) compared to the state (3.14%). Specifically, the Antelope Valley area (32.05%) is significantly higher than the state. Table 16: Percentage of Mothers with Late or No Prenatal Care Report Area Note: This indicator is compared with the state average. Data Source: California Department of Public Health, Birth Profiles by ZIP Code, Source geography: ZIP Code. Chronic Disease Prevalence and Incidence Diabetes Total Population Total Live Births Prenatal Care Started in 2nd Trimester Prenatal Care Started in 3rd Trimester No Prenatal Care Total Mothers with Late or No Prenatal Care Percent Mothers with Late or No Prenatal Care KFH 1,571,942 21,826 3, , % Panorama City Medical Center Service Area Antelope 419,491 6,247 1, , % Valley (Service Area) Panorama 1,152,451 15,579 1, , % City (Service Area) California 37,253, ,979 no data no data no data 15, % Diabetes is a condition that is a result of high blood sugar levels. There are three types of diabetes: Type I where the pancreas produces little or no insulin; Type II diabetes (most preventable); and Gestational diabetes (specifically expectant mothers). Type II is the most common diabetes and can be prevented by consuming whole grains, fruits and vegetables, limiting high fat or calorie foods, lean meat, fish, low-fat dairy products, reducing sweetened drinks, losing excess body weight and regular physical activity (LAC DPH, 2012). Diabetes risk factors include being obese, age, heredity, race/ethnicity, poor dietary habits, and lack of physical activity and history of diabetes during pregnancy. According to the report published by the Los Angeles County Department of Public Health (LAC DPH) Trends in Diabetes: A Reversible 34 P a g e

38 Public Health Crisis diabetes rates have increased from 6.6% in 1997 to 9.1% in 2007 (LAC DPH, 2012). Table 16: Diabetes Prevalence Report Area Total Population Population with Percent with (Age 20 ) Diabetes Diabetes 1,103,751 85, % KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) 292,227 22, % Panorama City (Service Area) 811,524 62, % California 26,721, ,022, % United States 239,583, ,015, % Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, National Diabetes Surveillance System, Source geography: County. Prevalence of diabetes in KFH - Panorama City Medical Center Service is higher than the state and is not meeting the state benchmark. The numbers reported are the percentage of adults aged 20 and older who have ever been told by a doctor that they have diabetes. Diabetes is a prevalent problem in the U.S; it may indicate an unhealthy lifestyle and puts individuals at risk for further health problems (CDC, 2009). Communities of Lancaster, Palmdale, North Hollywood, Pacoima, and Van Nuys had the highest estimated diabetes prevalence in KFH - Panorama City Medical Center Service Area (The Nielson Company., Thomson Reuters, 2012). Table 17: Diabetes Hospitalization (Per 100,000 Population) Report Area Patient Discharges for Diabetes Percentage of Total Discharges Crude Discharge Rate (Per 10,000 Population) Age-Adjusted Discharge Rate (Per 10,000 Population) KFH - Panorama City 2, % Medical Center Service Area Antelope Valley (Service % Area) Panorama City (Service 1, % Area) California 58, % Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, Source geography: ZIP Code. Overall diabetes related hospitalization among adults in KFH - Panorama City Medical Center Service Area may demonstrate that the rates are meeting the state benchmark; however, the rate of hospitalization in Antelope Valley (12.35 Per 100,000 Population) is higher than the state. Community residents in Antelope Valley expressed that there is a shortage of programs and counseling to deal with chronic diseases including diabetes. 35 P a g e

39 According to the data available, diabetes demonstrates high disparities among Blacks, Hispanic/Latino and White populations. An article from the Los Angeles County Department of Public Health (LAC DPH) Trends in Diabetes: A Reversible Public Health Crisis reports that in 2007, 12.8% of the Hispanic/Latino population, 11.4% of Blacks, 9.0% of Asian/Pacific Islanders and 5.7% of Whites had diabetes (LAC DPH, 2012). Graph 6: Diabetes Prevalence by Ethnicity Panorama City (Service Area) Antelope Valley (Service Area) California White Black Hispanic/ Latino American Asian/ Pacific Indian/Alaskan Islander Native Multi Race Race Unknown Panorama City (Service Area) 0.60% 1.12% 1.00% % 1.28% 0.96% Antelope Valley (Service Area) 0.93% 1.77% 0.91% % 1.22% 1.25% California 0.77% 1.62% 0.91% 0.85% 0.59% 0.87% 1.01% Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, Source geography: ZIP Code. Related indicators that were identified as possibly contributing to the increase in diabetes prevalence in KFH - Panorama City Medical Center Service Area could likely be a result of poverty, inadequate fruit and vegetable consumption and physical inactivity. In addition, environmental factors such as access to fast food restaurants, lack of park access, walk ability, lack of recreational and fitness facilities might be contributing to the higher rates of diabetes related health problems. It is also evident that the community residents do not seek preventative services and this was confirmed by the community leaders and health providers. Health providers stated that a high rate of patients are noncomplaint with prescription medications and do not keep their follow up appointments with the doctors. Obesity The County of Los Angeles Public Health Department s (LAC DPH) September 2012 article on the Trends in Obesity: Adult Obesity Continues to Rise, reports that Over the past decade, the obesity epidemic has emerged as one of the most significant public health threats in Los Angeles County and across the nation and also reports that about 23.6% of the adults (18 years or older) in Los Angeles County were obese (Los Angeles County Department of Public Health, 2012). According to the World Health Organization (WHO), overweight or obesity is an accumulation of excess body fat that affects a person s overall health. Overweight and obesity is calculated by using the Body Mass Index where the weight of the person (in kilograms) divided by the square of their 36 P a g e

40 height (in meters). Overweight is a BMI equal to or more than 25 and obesity is where the BMI is over 30 on the BMI scale (WHO, Obesity and Overweight Fact Sheet, 2012). Overweight and obesity is one of the most preventable health problems and causes of type II diabetes which could potentially lead to other chronic diseases such as heart disease, stroke, arthritis and many forms of cancers. The percentage of overweight adults in KFH - Panorama City Medical Center Service Area is slightly higher than the state and the national averages. Children who are obese have a higher risk of developing Type II Diabetes as an adult. Table 18: Percent of Obese Children Report Area Student Population Number Obese Percent Obese Tested KFH - Panorama City Medical 55,406 18, % Center Service Area Antelope Valley (Service Area) 17,397 5, % Panorama City (Service Area) 38,009 12, % California 1,300, , % Note: This indicator is compared with the state average. Data Source: California Department of Education, Fitnessgram Physical Fitness Testing Results, Source geography: School District. Adult overweight rates are higher in KFH - Panorama City Medical Center Service Area and are not meeting the state and national benchmarks. However, adult obesity rates are better than state and national benchmarks. On the contrary, youth overweight rates are better than state benchmark but youth obesity in KFH - Panorama City Medical Center Service Area is not meeting the state benchmark. Ethnic data for obese youth demonstrates high disparities between Hispanic/Latino, Black and Non- Hispanic American Indian/Alaskan Native populations. The rates of overweight among adults and obesity among youth are higher in KFH - Panorama City Medical Center Service Area compared to the state. The health need is likely being impacted by poverty rates, inadequate consumption of fruits and vegetables, physical inactivity, fast food access, lack of parks and walk ability along with lack of recreational facilities. Cardiovascular disease Cardiovascular disease is one of the leading causes of death in the U.S. Cardiovascular disease includes heart disease and stroke. Risk factors for cardiovascular disease (heart disease and stroke) include high blood cholesterol, high blood pressure, diabetes, tobacco use, overweight, obesity, diet, lack of physical activity, alcohol use, and family history, age, gender and ethnicity (CDC: Heart Disease and Stroke, 2012). 37 P a g e

41 Table 19: Heart Disease Prevalence Report Area Total Population (Age 18 ) Number with Heart Disease Percent with Heart Disease KFH - Panorama City Medical 1,189,293 69, % Center Service Area Antelope Valley (Service Area) 315,015 18, % Panorama City (Service Area) 874,278 50, % California 27,547,000 1,618, % Note: This indicator is compared with the state average. Data Source: California Health Interview Survey (CHIS), Source geography: County (Grouping). Even though the overall percentage of heart disease prevalence in KFH - Panorama City Medical Center Service Area is the same as the state, Antelope Valley heart disease prevalence is higher (5.97%) than the state (5.87%). Lancaster, Palmdale, Van Nuys, North Hollywood and Canyon Country have the highest number of congestive heart failure compared to other communities in KFH - Panorama City Medical Center Service Area (2012, Nielson Company, 2012 Thomson Reuters). Possible contributing factors for the high heart disease prevalence include poor dietary practices, choosing unhealthy foods from fast food restaurants, lack of regular physical activity in addition to poverty, and lack of nutritional knowledge. Table 20: Heart Disease Mortality Rate (Per 100,000 Population) Report Area Total Population Average Annual Deaths Death Rate (Per 100,000 Population) KFH - Panorama City Medical 1,511,828 1, Center Service Area Antelope Valley (Service Area) 419, Panorama City (Service Area) 1,092,488 1, California 36,634,623 44, HP 2020 Target <= Note: This indicator is compared with the Healthy People 2020 Target. Data Source: California Department of Public Health, Death Statistical Master File, Source geography: ZIP Code. Heart disease mortality rates in KFH - Panorama City Medical Center Service Area ( Per 100,000 Population) and the state ( Per 100,000 Population) are higher than the HP 2020 target (<=100.8 Per 100,000 Population). Overweight and obesity could lead to chronic diseases such as heart disease. Ethnic data for the heart disease mortality is not available for the entire KFH - Panorama City Medical Center Service Area; and a comparison between the ethnic groups with missing data sets is not viable. The national data demonstrates a high rate of heart disease mortality among Native American/Alaskan Natives, then Blacks, Hispanic followed by Whites (CDC, 2011). 38 P a g e

42 Total estimated cases for Congestive Heart Failure and Heart Attack seem to be high in Pacoima, Sylmar, North Hills, Granada Hills, Valencia, Panorama City, North Hollywood, Lancaster and Palmdale (The Nielsen Company, Thomson Reuter, 2012). High numbers of Coronary Heart Disease cases are evident in Pacoima, Sylmar, Granada Hills, Valencia, Sherman Oaks, Studio City, North Hollywood, Lancaster and Palmdale per the Thomson Reuter 2012 estimations (The Nielsen Company, 2012; Thomson Reuter, 2012). Estimated numbers of Stroke cases is higher in Lancaster, Palmdale, and Rosamond, Pacoima, Sylmar, Van Nuys, Sherman Oaks, North Hollywood, Studio City and Valley Village in KFH - Panorama City Medical Center Service Area (The Nielsen Company, Thomson Reuters, 2012). The health need for coronary heart disease and mortality could likely be impacted by poverty, low educational achievements, lack of physical activity, poor diet, lack of green space for physical activity, and walk ability. Cervical Cancer According to the National Cancer Institute, cervical cancer occurs in the tissue of the cervix (the organ connecting uterus and the vagina). The most common risk factor for cervical cancer is HPV infection. However, risky behaviors such as smoking can increase the risk for cervical cancer. Cervical cancer risk can be decreased by getting regular screening tests (Pap smear) or receiving HPV vaccination (NCI, What You Need to Know about Cervical Cancer, 2012). Table 21: Cervical Cancer Incidence Rate (Per 100,000 Population) Report Area Total Population, ACS Annual Incidence, Average KFH - Panorama City Medical Center Annual Incidence Rate (Per 100,000 Population) 1,565, Service Area Antelope Valley (Service Area) 416, Panorama City (Service Area) 1,148, California 36,308,528 3, United States 301,461,536 24,117 8 HP 2020 Target <= 7.1 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, Source geography: County. Cervical cancer incidence rate in KFH - Panorama City Medical Center Service Area (9.90) is higher than the state (8.30), the nation (8) and the HP 2020 (<=7.1) benchmarks. Ethnic data on the cervical cancer incidence for KFH - Panorama City Medical Center Service Area indicate that a high disparity exists among Hispanic/Latino, Whites and Asians. This is consistent with the state data. However, the national data shows the disparity to be among Hispanic/Latino, Blacks and then the White populations. Data on American Indian/Alaskan Natives is unavailable for 39 P a g e

43 KFH - Panorama City Medical Center Service Area level and the comparisons across the ethnicities for cervical cancer are inconclusive due to the missing data. Graph 7: Cervical Cancer Incidence Rate (Per 100,000) by Ethnicity White Black Asian American Indian / Alaskan Native Panorama City (Service Area) California Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, Source geography: County Antelope Valley (Service Area) United States Hispanic / Latino According to the Nielsen Company & Thomson Reuter 2012 estimates, communities such as Lancaster, Palmdale, Ridgecrest, Granada Hills, North Hills, and North Hollywood have the highest rates of cervical cancer compared to other areas in KFH - Panorama City Medical Center Service Area (The Nielsen Company, 2012, Thomson Reuters, 2012). STDs (Chlamydia Rates Per 100,000 Population) The rates of sexually transmitted diseases such as Chlamydia are high in KFH - Panorama City Medical Center Service Area (479.6) than the state (399.36) and the U.S (406.89). The primary data collected demonstrated a concern about unsafe sexual practices among youth and adults. Community residents and stakeholders brought up unsafe sexual practice repeatedly and suggested that education on safe sex and the effects of STDs on the cervical cancer incidence might encourage safer sexual practices. 40 P a g e

44 Graph 8: Chlamydia Rates (Per 100,000 Population) KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States. Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, Source geography: County. Colorectal Cancer The National Cancer Institute describes colon cancer as a cancer that develops in the tissue of the colon. The risk factors for colorectal cancer include family history, age 50 years or more, polyps in colon or rectum, smoking, diet and personal history of cancer (NCI, 2012). Colorectal cancer incidence rates are higher in KFH - Panorama City Medical Center Service Area (45.1) compared to the state (43.7), the nation (40.2) and the HP 2020 (38.6) per 100,000 population. Colorectal cancer demonstrates high disparities among Black, Whites and Asian and Hispanic/Latino sub-populations in KFH - Panorama City Medical Center Service Area. Graph 9: Colon and Rectum Cancer Incidence Rate (Per 100,000 Population) KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States HP 2020 Target Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, Source geography: County. 41 P a g e

45 Estimated incidences of colorectal cancer are higher in Lancaster, Palmdale, Ridgecrest, North Hollywood, Van Nuys, Valencia, Santa Clarita, Canyon Country, Granada Hills, Pacoima, Sylmar, Sherman Oaks and Studio City compared to other cities in KFH - Panorama City Medical Center Service Area (The Nielsen Company, 2012, Thomson Reuters, 2012). The high rates of colorectal cancer could likely being impacted by the related indicators such as inadequate fruit and vegetable consumption (adults), physical inactivity among adults, heavy alcohol consumption, tobacco usage, and access to liquor stores, access to fast food restaurants, and limited access to grocery store. Low rates of colon cancer screenings (sigmoid/colonoscopy), and higher rates of diabetes are additional drivers that could likely be contributing to the high rates of colorectal cancer incidences in KFH - Panorama City Medical Center Service Area. Mental Health The World Health Organization defines mental health as Health is a state of complete physical, mental and social wellbeing and not merely absence of disease or injury (WHO, 2012). The World Health Organization also describes poor mental health is associated with a stressful work environment, risk of violence, rapid social changes, unhealthy lifestyle and ill health. Persistent social stressors such as loss of employment, economic hardship, poverty and low level of education are also identified with poor mental health of an individual or community (WHO, 2010). In spite of the percent of adults with poor mental health in the Antelope Valley area of KFH - Panorama City Medical Center Service Area is lower than the state; the primary data from the Antelope Valley indicates a high need for mental health services. About 70% of the participants chose mental health as one of the top issues in their community. The outcome of poor mental health is homicide and suicide. Table 22: Percent with Poor Mental Health Report Area Total Population (Age 18 ) Number with Poor Mental Health Percent with Poor Mental Health KFH - Panorama City Medical 1,189, , % Center Service Area Antelope Valley (Service Area) 315,015 44, % Panorama City (Service Area) 874, , % California 27,547,000 3,914, % Note: This indicator is compared with the state average. Data Source: California Health Interview Survey (CHIS), Source geography: County (Grouping). Primary data findings for mental health needs in the Antelope Valley area are: Lack of psychiatrist accepting Medical Inpatient psychiatric beds for adults and children Mental health services for uninsured Lack of mental health services infrastructure 42 P a g e

46 Mental health programs for schools Psychiatric urgent care facilities Inpatient mental health units for children and adolescents Lack of psychiatric mobile response team to meet the demands Lack of support groups for domestic violence Low or no cost mental health counseling Anti-stigma campaign for mental health Resources for mental health education Mental health programs for foster families and kids Psychiatric hospital beds Antelope Valley community residents expressed a real urgency for mental health services and they shared that the isolation, distance from any major city for social life, and lack of social support are some of the reasons for mental and emotional health problems that not only affect adults, but also adolescents and children. Mental health issues were also brought up by the Panorama City residents especially for seniors with disabilities, caregivers and family members. IV. Who Was Involved in the Assessment VCCC was contracted to prepare the Kaiser Permanente Panorama City 2013 Community Health Needs Assessment. VCCC collaborated with Antelope Valley Partners in Health (AVPH) to assist with secondary and primary data collection in the Antelope Valley. VCCC was created in 1995 by eleven health care leaders to address the health care crisis facing our area when the county decided it would need to close clinics and hospitals. VCCC has evolved into the health and mental health planning body for SPA 2. From 1995 to 2000 VCCC was an allvolunteer organization consisting of individuals working in hospitals, clinics, consumer advocacy and county health care sites who shared responsibilities to create capacity reports so as to educate the Board of Supervisor's regarding the impact in the community by the closure of county hospitals and clinics. In addition this group also worked together to create the first collaborative 1994 CHNA as a result of SB697 for our catchment area. CHNA Experience VCCC has had a long history of conducting community health needs assessments (completed 2000, 2004, 2007 and 2010 that were SB697 compliant). In addition, VCCC completed a needs assessment for a SAMHSA funded project that focused on HIV, Substance Abuse and Hepatitis C in VCCC conducted CHNA dissemination meetings after each of the needs assessments were completed and presented the data at conferences and to groups wanting to learn more about completing CHNA using a collaborative approach. VCCC s past CHNA s have been completed collaboratively with multiple hospitals, clinics and community based organizations using the Mobilizing Action through Partnerships and Planning 43 P a g e

47 (MAPP) model. This model requires bringing stakeholders together to determine what needs to be accomplished, what information about the community can be collected and used in the CHNA. In addition, a comprehensive asset mapping was conducted to bridge the gaps in services. For this report VCCC has utilized the MATCH model. Due to the long history of working with the Los Angeles County Department of Public Health (LAC DPH), for the past four years, someone from their Office of Planning, Evaluation, and Development or the Office of Health Assessment has held a leading role on the VCCC CHNA data committee. VCCC used LAC DPH s maps, Morbidity and Mortality Report, and Community Survey Data in each of the 2007 and 2010 CHNA s. VCCC has experience with facilitating groups in CHNA s, strategic planning, and community based education sessions. V. Process and Methods Used to Conduct the CHNA Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. a. Secondary Data 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 web-based CHNA data platform to facilitate implementation of the CHNA process. 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. The secondary data for this report was obtained from the Kaiser Permanente CHNA data platform from October of 2012 to May of The data platform is undergoing continual enhancements and certain data indicators may have been updated since the date the data was obtained for this report. As such, the most updated data may not be reflected in the tables, graphs, and/or maps provided in this report. For the most recent data and/or additional health data indicators, please visit CHNA.org/kp 1 The types of indicators included on the CHNA platform are 1. Demographics (population, age, ethnicity, language) 2. Social & Economic Factors (poverty, uninsured, education, violent crimes, social support) 1 Note that updates have been made to some data indicators which may reflect a different data rate and/or map on the platform than those listed in the report. Please be aware of these changes and adjust if desired 44 P a g e

48 3. Health Behaviors (consumption of fruits/vegetables, alcohol, tobacco use, physical activity and breastfeeding) 4. Physical Environment (Fast food restaurants, grocery stores, liquor stores, park access, recreation and fitness facilities) 5. Clinical Care (FQHCs, HPSA, primary care physicians, vaccination rates, testing and preventative services) 6. Health Outcomes Morbidity/Mortality (asthma, obesity, diabetes, heart disease, cancers, STDs, dental, infant mortality, homicides, suicides and accidents) In addition to the CHNA data platform, secondary data was gathered using local, state and national health departments. For a complete list of sources and bibliography, please refer to Appendix D. Methodology for collection, interpretation and analysis of secondary data The Kaiser Permanente common indicator data is calculated to obtain unique service area rates. In most cases, the service area values represent the aggregate of all data for geographies (zip codes, counties, tracts, etc.) which fall within the service area boundary. When one or more geographic boundaries are not entirely encompassed by a service area, the measure is aggregated proportionally. The options for weighting small area estimations are based upon total area, total population, and demographic-group population. The specific methodology for how service area rates are calculated for each indicator can be found on the CHNA.org/kp website. Data gathered was analyzed using methods such as grouping and statistical analysis. Data was grouped according to the health conditions, co-morbidities, age, gender, ethnicity in addition to other specific needs for the CHNA report. Zip code level data collected was used to compare both areas (Panorama City and Antelope Valley) of KFH Panorama City Medical Center Service Area. This comparative data was presented to show the disparities between the two areas. Upon completion of secondary data collection, benchmarking was used as the first criteria to determine areas that performed poorly when compared to the state, nation and HP 2020 benchmarks. The second step in the analysis was to review health drivers and risky behaviors that led to poor health outcomes. Trend data was researched to compare if the health issue is improving or getting worse over time. 45 P a g e

49 b. Community Input How participants were identified by VCCC The long standing partnership and collaboration with various local agencies including L.A County departments helped VCCC to identify representatives from health and mental health who serve the broad interests of the communities in Panorama City. In addition, focus groups were conducted with patients, church members, parents and other community residents. Antelope Valley Partners in Health (AVPH), a collaborative partner, identified and conducted key informant interviews with Public Health and Mental Health experts, local leaders, and health care providers. In addition, AVPH partners conducted focus groups with community residents. Some of the public health experts participated in key informant interviews and focus groups. Such individuals were listed in both areas of participation. The community stakeholders that participated in the CHNA represented the broad interests of the community and included public health experts and other individuals knowledgeable about the health needs found in the community. The complete list of the stakeholders is provided for in the following tables. Name (Last, First, Academic Distinction) Baker, Shiarron BS Nursing Burke, Sloane, Ph.D, CHES Panorama City Medical Center Area Individuals with special knowledge of or expertise in public health Title Affiliation Description of public health knowledge/expertise Community Liaison Nurse Assoc. Professor LA County Department of Public Health CSUN Worked in Val Verde, Pacoima and California County Districts. Currently works with low-income families for the LAC DPH as a district nurse. Dept. of Public Health Areas of interest Latino health, women's health and college health. Date of Consult Type of Consult 11/13/2012 Key Informant Interview 10/1/2012 Focus Group Mathews, Gigi, Dr. PH Analyst III LAC DPH With Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. 1/9/2013 CHNA Data Committee Informant 46 P a g e

50 Name (Last, First, Academic Distinction) Mayen-Cho, Marie, MPH Melnick, Douglas, MD, MPH Nowland, Mary, PHN, RN Pomerance, Elise, MD, MPH Panorama City Medical Center Area Individuals with special knowledge of or expertise in public health Title Affiliation Description of public health knowledge/expertise Director of Providence Access to Care-Health Education Outreach Physician Specialist Public Health Nurse Supervisor Acting Area Health Officer for SPA 1 & 2 Providence Health and Services LAC DPH L.A. County Department of Health Services L.A. County Department of Public Health For the past 3 years working as the director of Access to Care-Health Education Outreach program at Providence Holy Cross hospital. Northeast Valley Public Health Manager, Director of Alzheimer's Association and prevention program. Worked in the public health field for many years. With Los Angeles County Department of Public Health in the STD clinic for SPA 1 & 2. Oversees the prenatal and family planning clinics at Antelope Valley Health Center and High Desert Health Systems. Clinical oversight of Public Health Centers and field services providing STD and tuberculosis services, communicable disease prevention and control and emergency preparedness and response. Date of Consult Type of Consult 11/5/2012 Key Informant Interview 1/9/2013 CHNA Data Committee Informant 9/19/2012 Key Informant Interview 9/25/2012 Key Informant Interview 47 P a g e

51 Name (Last, First, Academic Distinction) Mozian, Rita, MPH, CHES Panorama City Medical Center Area Individuals with special knowledge of or expertise in public health Title Affiliation Description of public health knowledge/expertise Health Educator LAC Dept. of Public Health, SPA 1 & 2 Has been working with low income, underserved populations over the past 7 years. Date of Consult Type of Consult 1/8/2013 Prioritization Process Participant Vigdorchik, Olga, MPH, MCHES Health Educator LAC Dept. of Public Health, SPA 1 & 2 With Los Angeles County Department of Public Health in the STD clinic for SPA 1 and 2 1/8/2013 Prioritization Process Participant Alvarez, Frank, MD, MPH Area Health Officer LAC Dept. of Public Health, SPA 1 & 2 With Los Angeles County Department of Public Health in the STD clinic for SPA 1 and 2 1/8/2013 Prioritization Process Participant Basiratmard, Siamak, MD Green, Stephanie, MD Maniago, Gladys, NP Medical Doctor Internal Medicine Medical Doctor Internal Medicine Nurse Practitioner Adult Clinic LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center Licensed and practicing clinician at safety net hospital and/or clinic 9/5/2012 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group Mendez- Nasrallah, Suzanna, NP Family Nurse Practitioner LAC DHS Olive View UCLA Medical Center Licensed and practicing clinician at safety net hospital and/or clinic 9/5/2012 Focus Group Phan, Melanie, MD Medical Doctor Internal Medicine LAC DHS Olive View UCLA Medical Center Licensed and practicing clinician at safety net hospital and/or clinic 9/5/2012 Focus Group 48 P a g e

52 Name (Last, First, Academic Distinction) Reznikova, Yuliya NP Blank, Joseph, MD Blank, Joseph,MD Cheng, Mindy, MD Cheung, Shung, MD Chin, Mun, MD Cope, Jacqueline, MD Correa, Blanca M.S. Darie, Silvia, MD Panorama City Medical Center Area Individuals with special knowledge of or expertise in public health Title Affiliation Description of Date of public health Consult knowledge/expertise Nurse Practitioner Adult Clinic Medical Director Medical Director Medical Doctor Internal Medicine Medical Doctor, Pediatrician Medical Doctor Internal Medicine Medical Doctor Family Medicine Community Liaison Medical Doctor Internal Medicine LAC DHS Olive View UCLA Medical Center Ambulatory Care Network (Olive View Mid- Valley Comprehensive Health Center) Ambulatory Care Network (Olive View Mid- Valley Comprehensive Health Center) LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center UCLA Community Liaison for UCLA CTSI Institute LAC DHS Olive View UCLA Medical Center Licensed and practicing clinician at safety net hospital and/or clinic Department of Health Services, Administration Department of Health Services, Administration LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center Licensed and practicing clinician at safety net hospital and/or clinic Licensed and practicing clinician at safety net hospital and/or clinic UCLA researches and comes together with communities that want to participate in research. LAC DHS Olive View UCLA Medical Center Type of Consult 9/5/2012 Focus Group 11/2/2012 Key Informan t Interview 9/5/12 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group 11/2/2012 Focus Group 9/5/2012 Focus Group 49 P a g e

53 Panorama City Medical Center Area Individuals consulted from Federal, tribal, regional, State or local health departments or other departments or agencies with current data or other relevant information Name (Last, First, Academic Distinction) Emmons, Jennifer, NP Title Affiliation Type of Department Family Nurse Practitioner, Family/Primary Care LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center Date of Consult Type of Consult 9/5/2012 Focus Group Fruto, Jean, NP Green, Stephanie, MD Huynh, Betty, NP Maniago, Gladys, NP Mathews, Gigi, MPH Mavrinaz, Maureen, MD Melnick, Douglas, MD, MPH Mendez- Nasrallah, Suzanna, NP Nurse Practitioner Family Medical Doctor Internal Medicine Nurse Practitioner Family Medicine Nurse Practitioner Adult Clinic Analyst III Medical Doctor Family Medicine Physician Specialist Family Nurse Practitioner LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DPH Office of Health Assessment and Epidemiology LAC DHS Olive View UCLA Medical Center LAC DPH SPA 1 & 2 LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DPH LAC DHS Olive View UCLA Medical Center LAC DPH LAC DHS Olive View UCLA Medical Center 9/5/2012 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group 1/9/2013 CHNA Data Committee Informant 9/5/2012 Focus Group 1/9/2013 CHNA Data Committee Informant 9/5/2012 Focus Group 50 P a g e

54 Panorama City Medical Center Area Individuals consulted from Federal, tribal, regional, State or local health departments or other departments or agencies with current data or other relevant information Name (Last, First, Academic Distinction) Ngugi, James, NP Nguyen, Diem-Thu, MD Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low income persons, minority populations and populations with chronic disease needs Leader / Rep. Name (Last, First) OR Member Type/# Description of leadership, representative, or member role What group(s) do they represent? (medically underserved, low income, minority population, population with chronic disease) 10 Adults CSUN Professors Group included Ph.Ds. with expertise in Public Health, Health Administration, Kinesiology, Nutrition, Social Services and Public Policy. 119 Adults CSUN Students Public Health and Health Administration Undergraduate students from CSUN 21 Youth New Direction for Youth participants 24 Clinicians Title Affiliation Type of Department Family Nurse Practitioner, Primary Care Medical Doctor, Internal Medicine Physicians, LAC DHS 55 Adults Church members, The Church on the Way 57 Parents Elementary School Parents\Community residents LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center Low-income, minority youth population. Licensed, practicing physicians, NPs, PAs from the L.A County Department of Health Services Church group members from multiple ethnicities, income and educational levels. Low-income, minority population in LAUSD Title 1 Schools. Date of Consult Date of Consult Type of Consult 9/5/2012 Focus Group 9/5/2012 Focus Group Type of consult 10/1/2012 Focus group 10/1/2012 CHNA Survey Tool 10/15/2012 Community Forum 9/5/2012 Focus group 9/30/2012 Morning 11:00 am Community Forum 10/22/2012 Survey Tool 51 P a g e

55 Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low income persons, minority populations and populations with chronic disease needs Leader / Rep. Name (Last, First) OR Member Type/# Description of leadership, representative, or member role 58 Adults Church members, The Church on the Way 66 Adults Church members, The Church on the Way 9 Adults Northeast Valley Health Corporation Diabetes and Hypertension Patients 10 Adults Community Residents of Antelope Valley 8 Adults Community Residents of Aguila, Ismael Alzubu, Ahmed, MD Aranda, Cesilla Antelope Valley Operation Manager, City of San Fernando AV Hospital Child & Family Guidance Center Arias, Jennie Registration Supervisor, AV Community Clinic Audrey, Simons Avila, Charles Director of Community Benefits, Grants Administrator MENFOLK/ YES2Kids What group(s) do they represent? (medically underserved, low income, minority population, population with chronic disease) Church group members from multiple ethnicities, income and educational levels. Church group members from multiple ethnicities, income and educational levels. Low-income, medically underserved, minority population dealing with chronic diseases Low-income, underserved population. Low-income, underserved population. Provides services for lowincome, minority population of the City of San Fernando. Population with chronic disease. Low-income, medically underserved, minority population, population with chronic disease. Low-income, medically underserved. Medically underserved, lowincome, minority population. Low-income, medically underserved, minority population. Date of Consult Type of consult 9/26/2012 Community Forum 9/30/2012 Afternoon 1:00 pm Community Forum 10/25/2012 Focus group 9/21/2012 Focus Group 9/13/2012 Focus Group 11/2/2012 Key Informant Interview 9/25/2012 Community Forum 9/25/2012 Community Forum 10/2/2012 Community Forum 11/2/2012 Key Informant Interview 9/25/2012 Community Forum 52 P a g e

56 Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low income persons, minority populations and populations with chronic disease needs Leader / Rep. Name (Last, First) OR Member Type/# Baker, Shiarron Berg, Barbara Description of leadership, representative, or member role Community Liaison Nurse, LAC DPH L.A. County Office of What group(s) do they represent? (medically underserved, low income, minority population, population with chronic disease) Medically underserved, lowincome, minority population. Low-income, medically underserved, minority population. Education Beyah, Cales Lancaster DCFS Low-income, medically underserved, minority population. Carter, Mark YES2Kids Low income, medically underserved, minority population. Castro, Cathy Chin, Soyem Christensen, Geraldine Clarkson, Erica Cook, James, MSW Cooperberg, Judy Corrales- Eneix, Sandy LA Community Development Commission Physician, AV Community Clinic Billing Manager, AV Community Clinic Family Nurse Practitioner, AV Community Clinic CEO of the Antelope Valley Partners for Health Executive Director, Mental Health America Palmdale School District Trustee Low-income, medically underserved, minority population. Low income, medically underserved Low-income Low-income, medically underserved Populations with chronic disease, medically underserved, low-income. Populations with chronic disease, medically underserved, low-income Medically Underserved, lowincome Date of Consult Type of consult 11/13/2012 Key Informant Interview 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 10/2/2012 Community Forum 10/2/2012 Community Forum 10/2/2012 Community Forum 9/21/2012 Key Informant Interview 9/14/2012 Key Informant Interview 9/13/2012 Key Informant Interview 53 P a g e

57 Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low-income persons, minority populations and populations with chronic disease needs What group(s) do they Leader / Rep. Description of represent? (medically Name (Last, leadership, underserved, low-income, Date of Type of First) OR representative, or minority population, Consult consult Member member role population with chronic Type/# disease) Curry Jr., Geroy DePaul, Garielle Derico, LaJuano Dhillon, Shelly Dunn, Jody Dupree, Erica PIP Family Nurse Practitioner, AV Community Clinic Clinical Manager, AV Community Clinic Disease Prevention Coordinator, AV Community Clinic Vice President, Service Integration for Partners in Care Foundation LA Community Development Commission Emanuel, Rich Family Nurse Practitioner, AV Community Clinic Faison, Eddy National Allegiance for Mental Illness (NAMI) Galvez, Gabriela Gilmore, Karen Gocke, James Child & Family Guidance Center Children's Bureau Family Nurse Practitioner, AV Community Clinic Low-income, medically underserved, minority population Low-income, medically underserved Low-income, medically underserved. Populations with chronic disease, medically underserved, low-income. Medically underserved, lowincome, minority population. Low-income, medically underserved, minority population. Low-income medically underserved. Low-income medically underserved, minority population, population with chronic disease. Low-income, medically underserved, minority population. Low-income, medically underserved, minority population, population with chronic disease. Low-income, medically underserved. 9/25/2012 Community Forum 10/2/2012 Community Forum 10/2/2012 Community Forum 10/2/2012 Community Forum 11/6/2012 Key Informant Interview 9/25/2012 Community Forum 10/2/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 10/2/2012 Community Forum 54 P a g e

58 Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low-income persons, minority populations and populations with chronic disease needs What group(s) do they Leader / Rep. Description of represent? (medically Name (Last, leadership, underserved, low-income, Date of Type of First) OR representative, or minority population, Consult consult Member member role population with chronic Type/# disease) Gonzalez, Michelle Guerrero, Virginia Hampton, Bobby Haynes, Mary Karels, Marleen Lawler, Opal Leitelt, Debi Berzon Bartz-Altadona Community Health Center Comprehensive Housing Info and Referral for People Living with HIV/AIDs Two Life Styles Family Nurse Practitioner, AV Community Clinic Protective Science Dynamics Child & Family Guidance Center L.A. County Dept. of Mental Health Low-income, medically underserved, minority population. Low-income medically underserved, minority population, population with chronic disease. Low-income, medically underserved, minority population. Low-income medically underserved. Low-income, medically underserved, minority population. Low-income, medically underserved, minority population. Low-income medically underserved, minority population, population with chronic disease. Low-income medically underserved Low-income 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 10/2/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum Lory, Quan Pediatrician, AV Community Clinic 10/2/2012 Community Forum Magnu, Rigina Clinical 10/2/2012 Community Coordinator, AV Forum Community Clinic Mahowald, AV Chess House Low-income 9/25/2012 Community Daa Forum Mahoward, AV Chess House Low-income 9/25/2012 Community Morgan Forum Matthews, PIP 9/25/2012 Community Monica Forum Low-income, medically underserved, minority population 55 P a g e

59 Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low-income persons, minority populations and populations with chronic disease needs What group(s) do they Leader / Rep. Description of represent? (medically Name (Last, leadership, underserved, lowincome, minority Consult consult Date of Type of First) OR representative, or Member member role population, population Type/# with chronic disease) Mayen-Cho, Marie Director of Providence Access to Care-Health Education Outreach Medically underserved, low-income, minority population 11/5/2012 Key Informant Interview Medrano, Maria Melnick, Douglas, MD, MPH Milla, Diana Luna Mostafanin, Shawn Nichols, Janet MENFOLK/ YES2Kids Physician Specialist Children Center of the AV Physician Assistant, AV Community Clinic Child & Family Guidance Center Nitescu, Missy Chief Operating Officer, Northeast Valley Health Corp. Parziale, Katie Family Nurse Practitioner, AV Community Clinic Perez, Ana Tarzana Treatment Center Low-income, medically underserved, minority population Medically underserved, low-income, minority population Low-income, medically underserved, minority population Low-income, medically underserved Low-income, medically underserved, minority population Medically underserved, low-income, minority population Low-income, medically underserved Low-income, medically underserved, minority population, population with chronic disease Perez, Jessica PSD Head Start Low-income, medically underserved, minority population Perez, Jose Consultant on the AV Mobility Management Project Low-income 9/25/2012 Community Forum 1/9/2013 CHNA Data Committee Informant 9/25/2012 Community Forum 10/2/2012 Community Forum 9/25/2012 Community Forum 11/13/2012 Key Informant Interview 10/2/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/13/2012 Key Informant Interview 56 P a g e

60 Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low-income persons, minority populations and populations with chronic disease needs Leader / Rep. Name (Last, First) OR Member Type/# Description of leadership, representative, or member role What group(s) do they represent? (medically underserved, lowincome, minority population, population with chronic disease) Date of Consult Type of consult Perkins, Kimberly First City Savings Low-income 9/25/2012 Community Forum Pineda, Mayra Back Office, AV Community Clinic Low-income, medically underserved 10/2/2012 Community Forum Randall, Jim Reyes, Carmen Reynolds, Dorothy Robles, Cindy Outreach Coordinator, LAC DMH Community Resident PSD Head Start Asian Youth Center, AV Medically underserved, low-income, minority population Low-income, medically underserved, minority population Low-income, medically underserved, minority population Low-income, medically underserved, minority population 11/6/2012 Key Informant Interview 9/13/2012 Focus group 9/25/2012 Community Forum 9/25/2012 Community Forum Rodriguez, Trina Quality Assurance Low-income 10/2/2012 Community Forum Rosas, Valerie West Coast Drug and Alcohol Recovery Low-income, medically underserved, minority population, population 9/25/2012 Community Forum Ross, Laurie Schallert, Larry Scott, Sylvia License Clinical Social Worker (LCSW), Antelope Valley Hospital Director of Program Development, Child and Family Center The Catalyst Foundation with chronic disease Populations with chronic disease, medically underserved, low-income Medically underserved, low-income, minority population Low-income, medically underserved, minority population, population with chronic disease 10/3/2012 Key Informant Interview 11/5/2012 Key Informant Interview 9/25/2012 Community Forum 57 P a g e

61 Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low-income persons, minority populations and populations with chronic disease needs Leader / Rep. Name (Last, First) OR Member Type/# Shulman, Dee Dee Speyer, Winter Steans, Tynisha Stennett, Cecil Toliver, Cynthia, MSW Umubgba, Oghenesume Woods, Cindy Description of leadership, representative, or member role DCFS Comprehensive Housing Info and Referral for People Living with HIV/AIDs The Catalyst Foundation The Catalyst Foundation Chairperson of the Older and Disabled Case Management Committee at Antelope Valley Partners for Health Psychiatrist, AV Community Clinic Billing, AV Community Clinic What group(s) do they represent? (medically underserved, low-income, minority population, population with chronic disease) Low-income, medically underserved, minority population Low-income, medically underserved, minority population, population with chronic disease Low-income, medically underserved, minority population, population with chronic disease Low-income, medically underserved, minority population Populations with chronic disease, medically underserved, low-income Populations with chronic disease, medically underserved, low-income Low-income, medically underserved Date of Consult Type of consult 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/27/2012 Key Informant Interview 10/2/2012 Community Forum 10/2/2012 Community Forum Yadon, Lesley Children's Bureau Low-income, medically underserved, minority population 9/25/2012 Community Forum 58 P a g e

62 Methodology for collection and analysis of primary data Primary data was collected utilizing various methods such as key informant interviews, community forums, focus groups with both health professionals and community residents, and finally through paper surveys that were administered to residents, community stakeholders, students of community colleges and California State University, Northridge (CSUN) public health students and online surveys with health care providers and residents. Key Informant Interviews: A total of 17 key informant interviews were conducted for KFH - Panorama City Medical Center Service Area. Each interview lasted between 30 to 45 minutes. The key informants included individuals from Los Angeles County health, mental health and public health departments, academia, community clinics, hospitals, and LA school district staff with public health expertise or provide services for low-income, uninsured families in KFH - Panorama City Medical Center Service Area. For key informant interview questionnaire please refer to Appendix B. Community Forums: Seven one hour community forums with 268 participants were conducted using TurnPoint Technology response system; where the participants used a clicker to answer the questions. A PowerPoint survey was created on the TurnPoint Technology response system and each participant was given a clicker for responding. This system helped VCCC to gather more honest responses from the participants. Focus Groups: Utilizing a focus group facilitation guide, VCCC conducted seven one hour focus groups with 86 community members, leaders, and service providers. Out of the 7 focus groups, three were done in Spanish. For a copy of the facilitation guide and focus group questions, please refer to Appendix C. Community Surveys: A total of 346 surveys (both paper and online) were administered to participants consisting of public health professionals, health care providers, community residents, parent groups from Los Angeles Unified School District (LAUSD) and CSUN students. These surveys were created in both English and Spanish. Primary data was collected for most significant health problems in the community such as significant social and economic issues faced by the community, risky behaviors, and the top 5 health issues in the community. In addition, each group was asked to rank the top 5 health issues facing them personally and their community by providing a list of health needs that did not meet the state, the national and/or Healthy People 2020 benchmarks. Upon completing the primary data collection, VCCC CHNA team scheduled a debriefing meeting to create a story board to draw out the common themes from all the key informant interview, focus groups, community forums and survey input. Once the most common and compelling themes were 59 P a g e

63 identified, they were categorized as health needs, access, risky behaviors, environment, socioeconomic, barriers, solutions and assets. The frequency of each theme was then counted to rank the themes from most immediate need to intermediate need. Primary data reiterated the findings from secondary data. Health needs that emerged from both primary and secondary data collection were combined into one list for prioritizing the top 10 immediate needs of the KFH Panorama City Medical Center Service Area. b. Data limitations and information gaps 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. The timeframe also restricted the collection of complete information (updated information on phone numbers, programs) on assets available in the community assets. Due to the budget cuts, many community based programs in the hospital service area have been either cut or eliminated. VI. Identification and Prioritization of Community s Health Needs a. Identifying community health needs For the purposes of the CHNA, Kaiser Permanente defines health need as a poor health outcome and its associated health driver(s) or a health driver associated with a poor health outcome where the outcome itself has not yet arisen as a need. Health needs arise from the comprehensive identification, interpretation, and analysis of a robust set of primary and secondary data. Subsequent to collection and analysis of the primary and secondary data, a comprehensive list of identified needs were provided to the health care experts, providers, stakeholders, community leaders and government representatives for the purpose of ranking the top needs in the community. The following broad based health needs were identified and formed the starting point for prioritization of community health needs: 60 P a g e

64 Social & Economic Factors High School Graduation Rate (AV, PC) Population with No High School Diploma (AV,PC) Student Reading Proficiency (4 th Grade) (AV, PC) Children in Poverty (AV) Free and Reduced Price School Lunch Eligibility (AV, PC) Poverty Rate (< 100% FPL) (AV,PC) Population Below 200% of Poverty Level (AV, PC) Supplemental Nutrition Assistance Program (SNAP) Recipients (AV, PC) Lack of Social or Emotional Support (Adult) (AV, PC) Teen Births (AV, PC) Unemployment Rate (AV, PC) Population Receiving Medicaid (AV, PC) Uninsured Population (PC) Linguistically Isolated Population (PC) Physical Environment Grocery Store Access (AV, PC) Park Access (AV, PC) Recreation and Fitness Facility Access (AV, PC) Health Outcomes Asthma Hospitalization Adult (AV, PC) Asthma Hospitalization Youth (AV) Diabetes Hospitalization Adult (AV) Diabetes Hospitalization Youth (AV) Diabetes Prevalence (AV, PC) Overweight Adult (AV) Obesity Youth (AV, PC) Overweight Youth (PC) Cancer Mortality (AV) Cervical Cancer Incidence (AV, PC) Colon Cancer and Rectum Cancer Incidence (AV, PC) Low Birth Weight (AV, PC) Poor Dental Care (AV, PC Suicide (AV) Poor General Health (AV, PC) Heart Disease Prevalence (AV) Heart Disease Mortality (PC) Stoke Mortality (AV) Homicide (AV) Chlamydia Incidence (AV, PC) HIV Hospitalizations (AV, PC) HIV Prevalence (AV, PC) Premature Death (AV) Motor Vehicle Crash Death (AV) Pedestrian Motor Vehicle Death (AV) Clinical Care Population Living in a Health Professional Shortage Areas (HPSA)(AV, PC) Lack of a Consistent Source of Primary Care (AV, PC) Access to Primary Care (AV, PC) Absence of Dental Insurance Coverage (AV, PC) Dental Care Utilization (Adult) (AV, PC) Dental Care Utilization (Youth) (AV, PC) 61 P a g e

65 b. Process and criteria used for prioritization of the health needs The methodology used for prioritization of identified health needs was the multi-voting approach. Health needs in low-income areas are many and varied. Multi-voting approach is an effective method to reduce long list into a more compact list of major health needs. The prioritization process was conducted using the following steps: Step 1: Identified and recruited 40 to 50 key leaders and residents to prioritize the identified health needs. Two meetings took place in Antelope Valley on Jan. 8, 2013 and Panorama City on Jan.11, Step 2: VCCC CHNA team, AVPH and KFH Panorama City Community Benefits staff participated in a meeting to establish the following criteria for the prioritization. 1. Does the issue impact both the Antelope Valley and Panorama City? 2. How severe is the problem (i.e. meeting benchmarks state, nation or Healthy People)? 3. Is the issue getting worse over time? 4. Has the community ranked the issue over other issues? 5. Are there reasonable resolutions to the problems? Step 3: Health Need Profiles were created for those specific needs that did not meet the benchmarks for either the county, the state, the U.S. and/or HP 2020 in addition to the needs identified by the community members as high priority needs. Participants received health need profiles and the above criteria to prepare for the prioritization meetings. Step 4: Individuals were asked to rank what they consider to be the 10 most immediate and significant health needs followed by ranking the next 15 intermediate needs. Individuals were then put into small groups where they compared individual rankings to reach consensus of the top 10 needs. Finally, the entire group collectively ranked the top 25 needs eliminating duplicates. There was a final round of voting for those that wanted to participate in an online survey to reach consensus to identify the 10 most immediate needs for KFH Panorama City Medical Center Service Area. Immediate needs are those identified as crucial and need immediate attention. The rest of the needs were categorized as intermediate needs so that KFH-Panorama City Medical Center will take these needs into consideration for future implementation strategy. Step 5: Results were tabulated at the end of each round resulting in the following prioritized list of needs. Prioritized description of community health needs Due to the uniqueness of the Antelope Valley and Panorama City areas, even though there is an overlap of the needs, the top 10 needs from each area differ slightly. The following topics are either a top concern for both areas or unique to a specific area. 62 P a g e

66 List of Community Health Needs KFH Panorama City Medical Center Service Area Panorama City Access to Primary Care Obesity Adult/Youth Mental Health/Depression Dental Health 4 8 Uninsured Population 5 2 Physical Environment/Transportation 6 4 Poverty Rates Diabetes 8 6 Prenatal Care 9 5 Breastfeeding 10 6 Wellness and Health Education Programs 7 Vision 10 Care Coordination 9 Asthma 7 Unemployment 10 Cardiovascular Disease 8 Antelope Valley Additional community health needs identified by participants as intermediate needs in order of priority from highest to lowest consisted of the following: Cancer 12.Domestic Violence 13.Cardiovascular Disease 14. Asthma 15. HIV 16. Unemployment 17. Chlamydia and other STDs 18. Suicide 19. Hypertension 20. Substance Abuse 21. Lack of Social and Emotional Support 22. Teen Birth 23. Tobacco Use 24. Population without High School Diploma 25. Vision Care Comprehensive health need profiles located under Appendix A were created for all of the above issues except for wellness and health education programs, vision, and care coordination. These three issues were key concerns in primary data collection, however, upon research, no specific KFH Panorama City Medical Center Service Area data was found. Access to Primary Care A major concern identified during primary data collection and supported by the secondary data is the lack of primary care physicians with some of the physicians unwilling to accept Medi-Cal. The percentage of the population living in a health professional shortage area in California is 57.14% which is better than the 60.80% rate of the United States. However in the Antelope Valley area, the 63 P a g e

67 rate is 90.68% which exceeds the 60.96% in Panorama City and the combined area rate of 67.86%. A health professional shortage area is a geographic area that has a shortage of primary medical care, dental and mental health professionals. More specific to this issue is the shortage of bilingual staff mainly Spanish speaking, which according to the monolingual community residents acts as a barrier to accessing care. Obesity and Overweight (Adults and Youth) Percentage of adults who are obese (BMI 30.0) in Antelope Valley SPA 1 (34.8%) is much higher than SPA 2 (21.1%), Los Angeles County (23.6%) and the U.S. (28.3%) according to the 2011 Los Angeles County Survey. In addition, a rate of overweight adults in the medical center service area (36.42%) is above the state average (36.20%). Additionally both adults (24.82%) and youth (43.37%) are less active than the state adult (22.70%) and youth (37.45%) for physical activity. A lack of physical activity and poor eating habits leads to obesity and overweight in both adults and youth. Obesity among youth in KFH - Panorama City Medical Center Service area (33.75%) is higher compared to the state average (29.82%). Percentage of overweight youth (14.09%) is slightly lower than the state average (14.30%). These numbers are for youth in grades 5, 7 and 9 that were ranked high risk on the fitness gram. High risk is determined for girls between 28.4% and 38.6% and boys between 27% and 35.1% body fat. Many of the primary care physicians have expressed concern about the higher numbers of children with Type II Diabetes and Fatty Liver diagnosis. Research has shown that overweight and obese children tend to be overweight and obese adults. Mental Health Adults in the KFH Panorama City Medical Center Service Area did self-report (14.05 %) slightly better mental health than the state average (14.21%) when asked if they felt they needed to seek professional help in the last 12 months for their problems inclusive of substance abuse. A key informant interview with leadership from the Los Angeles County Department of Mental Health in the area shared two major concerns stating that Safety and stabilization occurs too often as an impatient in the hospital setting because there is such limited, (almost no) access to outpatient services which is less intensive especially for low-income and uninsured population. Adults reported a lack of adequate social and emotional support in KFH - Panorama City Medical Center Service Area (71.19%) compared to the state (75%). This is an important indicator for good mental health outcomes. Dental Care Community stakeholders identified dental care as a major concern. In KFH - Panorama City Medical Center Service Area, the high percentage of adults (34.65%) who self-report they have not visited a dental professional in the past year which is worse than the state average of (30.51%). In addition, 12.22% of teens have not had a dental visit in the past year again faring worse than the state average (10.07%). These numbers are in alignment with the number of adults without dental insurance in the 64 P a g e

68 area (37.36%) which is also worse than the state (33.72%). Many stakeholders were concerned that folks underestimate how vital good dental health is to a person s overall general health. Uninsured Population Economic instability has led to the loss of jobs and employer based group health insurance. In the report area 20.81% of the population is uninsured. When looking at Antelope Valley (16.47%) and Panorama City (22.37%) individually the Panorama City area is worse off. The area rate (20.81% is worse than the state (17.92%) and the nation (15.05%). The lack of insurance is a primary barrier to health access including primary care and specialty care. Physical Environment/Transportation Because of the unique situation in the Antelope Valley, in 2008 the Los Angeles County Metropolitan Transportation Authority (METRO) and the Antelope Valley Transit Authority (AVTA) signed a Memorandum of Understanding (MOU) to conduct and implement a Mobility Management Plan for the area. Conducting surveys was part of the process and the report states that 58% of individuals trying to access social services including health care services reported some difficulty with transportation. The Antelope Valley area of KFH-Panorama City Medical Center Service Area has 2,812 square miles with people per square mile. The low density rate makes accessing public transportation difficult for those without a vehicle. Transportation issues were also a concern for the Panorama City area; however, the main issue in the more urban and densely populated portion of the medical center service area dealt more with high gas prices and inability to afford public transportation whose prices are increased annually. When residents do not have access to personal transportation both distance and income are factors that create barriers to accessing health care services. Poverty Rates The population living below 200% FPL in Antelope Valley (40.97%) far exceeds that of Panorama City (35.40%). The report area average (36.86%) exceeds the state (32.83%). Additionally, the rate of children living in poverty between the ages of 0 and 17 for Antelope Valley (26.77%), Panorama City (18.96%), and the entire KFH Panorama City Medical Center Service Area (21.33%) exceeds the state (19.06%) rate. Many of the stakeholders shared concerns about the economy and how greater numbers of formerly middle class families are falling into those living at or just above the poverty rate. Poverty impacts the entire family and in the KFH Panorama City Medical Center Service Area disproportionally affects the Latino population. Diabetes The rate of diabetes hospitalizations in Antelope Valley (12.35 Per 10,000 Population) fares much worse than Panorama City (8.02 Per 10,000 Population). However, the combined rate of diabetes in KFH Panorama City Medical Center Service Area (9.17 Per 10,000 Population) is lower than the state (10.40 Per 10,000 Population). Even though the combined rate is meeting the state benchmark, diabetes still is a health concern for the community members and health care providers. Diabetes 65 P a g e

69 death rates in Antelope Valley (40.6 Per 100,000 Population) and in SPA 2 where Panorama City area is located it is 15.7 per 100,000 population. Antelope Valley has more than doubled the death rates per 100,000 population than L.A. County (20.2 Per 100,000 Population) and the nation (20.8 Per 100,000 Population). Increased rates of diabetes hospitalizations may indicate unhealthy lifestyles and poor management of A1C blood glucose levels, poor eating habits, and lack of physical activity. Other contributing factors for diabetes include preventable hospital events, lack of primary care access, transportation issues, increased obesity rates, and sedentary lifestyles. On the surface it appears there is a need for diabetes management education. Untreated diabetes can put people at risk for higher rates of hospitalization, neuropathy, blindness, amputation, kidney disease/failure and death. Prenatal Care Low birth weight infants (under 2500g) in the report area (7.43%) with Antelope Valley (8.98%) and Panorama City (6.81%) fare worse than the state (6.80%). This indicator is relevant because low birth weight infants are at high risk for health problems and extended hospitalizations. There are higher rates of teen births in Antelope Valley (11.10per 1,000 females under age 20) when compared to Panorama City (7.4) and the state (8.46). Breastfeeding Early breastfeeding rates in Antelope Valley (90.29%) and Panorama City (90.94%) are closer to state rates (91.74%). However, exclusive breastfeeding rate was brought up as a concern by the community health educators and lactation education was recommended for improving the rates of exclusive breastfeeding in the KFH Panorama City Medical Center Service Area. Breast feeding has positive health benefits and may lower infant mortality rates. Stakeholders identified Black infant mortality as high in the Antelope Valley, however there was an improvement since the Black Infant Health Program was created by Antelope Valley Partners for Health. VII. Community assets and resources available to respond to the identified health needs of the community The following tables include a list of existing health care facilities (hospitals and community clinics) that offer primary care in the KFH - Panorama City Medical Center Service Area. Hospitals and clinics are valuable resources in the community offering primary care and specialty care; in addition to programs and support services that address many of the identified health needs contained in this report (i.e. asthma, diabetes, weight management, nutrition etc.). A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH - Panorama City Medical Center Service Area are attached under Appendix C. 66 P a g e

70 Hospital listing from the Office of Statewide Health Planning and Development (OSHPD) Agency Address City Zip Telephone Number Antelope Valley Hospital 1600 West Ave. J Lancaster Acute Care (inpatient and outpatient care) Henry Mayo Newhall McBean Valencia Memorial Hospital Parkway Acute Care (inpatient and outpatient care) Hollywood Community Emelita St. Van Nuys Hospital of Van Nuys Acute Psychiatric Care (inpatient and outpatient care) Kaiser Permanente Cantara St. Panorama City Acute Care (inpatient and outpatient care) Kaiser Permanente 5601 De Soto Ave Woodland Hills Acute Care (inpatient and outpatient care) Mission Community Roscoe Blvd. Panorama Hospital City Acute Care (inpatient and outpatient care) Olive View / UCLA Olive View Dr. Sylmar Medical Center Acute Care (inpatient and outpatient care) Pacifica Hospital of the 9449 San Fernando Rd, Sun Valley Valley Acute Care (inpatient and outpatient care) Providence Holy Cross Rinaldi St. Mission Medical Center Hills Acute Care (inpatient and outpatient care) Sherman Oaks Hospital and Burn Center 4929 Van Nuys Blvd. Sherman Oaks Acute Care (inpatient and outpatient care). Valley Presbyterian Vanowen St. Van Nuys Hospital Acute Care (inpatient and outpatient care) Public and Community Clinics Agency Address City Zip Telephone Number AHF Healthcare Center 4835 Van Nuys Blvd, Sherman Valley Suite 200 Oaks` The AHF Healthcare Center cares for patients with HIV. It offers advanced treatment options and specialist referrals to meet each patient's needs. 67 P a g e

71 Comprehensive Community Center (formerly Professional Medical Group) Victory Blvd. North Hollywood Everyone seeking screening or care is accepted regardless of ability to pay Primary and specialty care is provided for newborns to seniors All sites are CPSP providers and all sites are CHDP providers Dental care Disease and behavioral management programs All sites have Medi-Cal eligibility workers Staffs provide culturally and linguistically sensitive care El Proyecto del Barrio 8902 Woodman Arleta Ave. Basic medical services, and other services, including: physicals for children (CHDP), immunizations, TB testing for children, treatment for illnesses, adult medical care, pregnancy testing, maternal -prenatal care, WIC. Referrals (Supplemental Food Program) HIV testing, PAP smears and mammograms. Kennedy High School Based Gothic Ave. Granada Clinic Hills Services include physical exams, sports physicals, treatment for minor illnesses, and immunizations/tb testing for students and their siblings from 8-18 years of age. Information on no cost or low cost health insurance and food stamp enrollment is provided. L.A. Mission College, Eldridge Ave. Sylmar Student Health Center Provides medical services including physical exams, testing for students MaClay Health Center for Pierce St. Pacoima Children Routine health care provided by internists, pediatricians, family medicine specialists, gynecologists, obstetricians, nurse practitioners, midwives, physicians assistants or other health care providers who serve as the first point of contact with the health care system. Services focus on the prevention and early detection of health problems through regular physical examinations, blood pressure checks, mammograms and other similar procedures as well as therapeutic services for people who do not require specialty care. Meet Each Need with N. San Pacoima Dignity (MEND) Fernando Road MEND offers food, clothing, medical, eye care, dental, multi-benefit screenings, and education and training services for those in need. Mission City Community Sepulveda Mission Network Mission Hills Blvd, Suite 300 Hills MCCN services are provided in a culturally and linguistically sensitive and competent manner and services are provided by bilingual and/or bicultural staff. A range of health care services for your family's health needs are available at very low cost or NO cost for persons who qualify. MCCN participates as a healthcare provider in several programs for low-income individuals and families. Former Medi-CAL recipients and other low-income persons are encouraged to inquire about these special programs 68 P a g e

72 Mission City Community Parthenia St. North Hills Network, Inc.(North Hills) Mission City Community Network, Inc. offers a range of health care services for your Family's Health Needs at very low cost or NO cost for persons who qualify. MCCN's current services are provided by bilingual and/or bicultural staff. Mission City Community 9919 Laurel Canyon Pacoima Network Pacoima Middle School Blvd. Mission City Community Network offers a range of health care services for your Family's Health Needs at very low cost or NO cost for persons who qualify. MCCN's current services are provided by bilingual and/or bicultural staff. Newhall Health Center Newhall Ave Newhall (Samuel Dixon Family Health Center) Offer medical services and immunizations for families with any level of income. We are not a free clinic, but we offer a competitive sliding fee scale to fit your needs. You and your family can still receive affordable health care! Provide a wide range of high-quality primary care services, including: Minor illness and injury, diabetes management, physical exam health. Northeast Valley Health 7843 Lankershim North Corporation Blvd Hollywood Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Northeast Valley Health 1600 San Fernando San Corporation Rad Fernando Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Northeast Valley Health Corporation O Melveny Ave. San Fernando Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Northeast Valley Health 6551 Van Nuys Blvd, Van Nuys Corporation Suite 201 Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Northeast Valley Health Corporation Homeless Mobile Clinic 1172 N. Maclay Ave San Fernando Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. 69 P a g e

73 Northeast Valley Health Valencia Blvd. Valencia Corporation LAC Valencia Health Center Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Pediatric Health And WIC 7138 Van Nuys Blvd. Van Nuys Center Provides pediatric and women, infant health services. Planned Parenthood Los 7100 Van Nuys Blvd, Van Nuys Angeles Van Nuys Center Suite 108 Provides up-to-date, clear, medically accurate information that helps patients with better understanding of their sexual health. Pregnancy Counseling Sepulveda Mission Center Blvd. Hills Offer Free Support and Referrals Free Pregnancy Testing and Free Limited Obstetrical Ultrasounds, Pregnancy Verification / Proof of Pregnancy, Facts about Abortion Methods and Risks, STDs Information (Sexually Transmitted Diseases), Post Abortion Counseling Information on Family Planning Samuel Dixon Family Health Center Canyon Country Clinic Camp Plenty Rd, Suite 2 Canyon Country We offer medical services and immunizations for families with any level of income. We are not a free clinic, but we offer a competitive sliding fee scale to fit your needs. You and your family can still receive affordable health care! We provide a wide range of high-quality primary care services, including: Minor illness and injury, Diabetes management, Physical exams, Family medicine, Women's health, Prenatal and well-baby care, Immunizations, Health education. Additionally, we offer quarterly diabetes, screenings and an annual breast cancer screening. Samuel Dixon Family Health San Martinez Val Verde Center, Inc. (Castaic) We offer medical services and immunizations for families with any level of income. We are not a free clinic, but we offer a competitive sliding fee scale to fit your needs. You and your family can still receive affordable health care! We provide a wide range of high-quality primary care services, including: Minor illness and injury, diabetes management, physical exams, family medicine, women's health, prenatal and well-baby care, immunizations, health education. Additionally, we offer quarterly diabetes screenings and an annual breast cancer screening. Santa Clarita Medical and Arch St. Newhall Mental Health Services Provides counseling services. Santa Clarita Valley (SCV) Valencia Blvd. Valencia Pregnancy Center Provides pregnancy testing, ultrasound pregnancy confirmation, abortion information, and post-abortion services. (24 hour toll free services) 70 P a g e

74 Sun Valley Health Center 7223 N. Fair Ave. Sun Valley Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Valley Community Clinic 6801 Coldwater North Canyon Blvd. Hollywood Anger management for adults and teens, behavioral health service, community outreach, counseling, dental, general medical, HIV AIDS, Nutrition and exercise counseling, medical research, optometry, pediatrics, prenatal services, Valley teen-clinic health education, women's health and family planning. Van Nuys Medical and Mental Health Services 6265 Sepulveda Van Nuys Blvd. Provide high quality health care services to the local community. Community clinic providing a range of outpatient, nonemergency health care. Universal Primary Care 1560 E. Chevy Chase Dr. #245 Glendale Provides medical services. Telfair School Health Center Telfair Ave. Pacoima Complete vision examinations by optometrists (referral by school nurse, school or parent). Services offered at low cost for children of low-income families. 71 P a g e

75 Appendix A: Health Need Profiles After prioritizing the top 10 immediate needs for both West Ventura and West San Fernando Valley and East Ventura County, it was noted that the top 10 needs for them were slightly varied. Taking this into consideration, health need profiles were created for all top 10 most immediate needs for both areas (which included three additional needs). Therefore, this appendix includes a total of 14 health profiles and the profiles are organized in alphabetical order for easier access. 72 P a g e

76 Health Need Profile: Access to Primary Care About Access to Primary Care Why is it important? Lack of access to care presents barriers to good health. Some of these barriers are supply and accessibility to facilities and physicians, rate of uninsured, financial hardship, transportation barriers, cultural competencies, and coverage limitations affecting access. Rates of morbidity, mortality, and emergency hospitalization can be reduced if community residents have access to services such as regular health checkups, preventative screenings, routine tests, and vaccinations. Primary Care Provider Rate (Per 100,000 Population) KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States Primary care provider rates per 100,000 population in KFH Panorama City Medical Center Service Area (80), are not meeting the state (83.2) or national (84.7) benchmarks. The Antelope Valley rate (78.2) is even lower than Panorama City (80.6). This indicator is important because it has a negative impact on access to primary care. Percent Without a Primary Care Doctor 16.31% 16.70% 16.17% 14.23% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California The percentage of population without a regular doctor in KFH Panorama City Medical Center Service Area is higher (16.31%) compared to the state (14.23%). 73 P a g e

77 The lack of access to primary care was brought up by the community members and was ranked as their top community need. The barriers to accessing the available primary care services were identified by the community as transportation, location and hours of operation of the primary care clinics. Designated Health Professional Shortage Areas (HPSA) "Health Professional Shortage Areas" (HPSAs), is defined as having shortages of primary medical, dental or mental health providers. A shortage of health care professionals contributes to access and health status issues. Percent of Designated Population Underserved Report Area Total Population, 2010Census HPSA Designation Population Underserved Population Percent of Designated Population Underserved KFH Panorama City 1,574, , , % Medical Center Service Area Antelope Valley (Service 421,691 42,171 38, % Area) Panorama City (Service 1,152, ,324 84, % Area) California 37,267,509 5,171, ,955, % United States 312,676,557 52,826, ,117, % Data Source: U.S. Health Resources and Services Administration, Health Professional Shortage Area File, Source geography: Address. KFH Panorama City Medical Center Service Area has a high percentage of underserved population (67.86%). Both Antelope Valley (90.68%) and Panorama City (60.96%) are higher than the state (57.14%) and the U.S (60.80%) and are not meeting benchmarks. The issue of physician shortage was brought up by the community residents, leaders and key informants during the primary data collection process. Shortage of mental health professionals was identified as the one of the top 10 needs in the KFH Panorama City Medical Center Service Area. Table 23: Number of FQHC s Report Area Number of Federally Qualified Health Centers KFH Panorama City Medical Center 20 Service Area Antelope Valley (Service Area) 5 Panorama City (Service Area) 15 California 637 United States 5,459 Data Source: U.S. Health Resources and Services Administration, Centers for Medicare & Medicaid Services, Provider of Service File, Source geography: Address. 74 P a g e

78 There are only 20 Federally Qualified Health Centers (FQHCs) in KFH Panorama City Medical Center Service Area. The limited number (5) FQHCs in Antelope Valley creates an even larger barrier for the community residents to access health care and receive preventable health services such as regular checkups, tests, vaccinations etc. Preventable Hospital Event Report Area Patient Discharges for Ambulatory Care Sensitive (ACS) Conditions Percentage of Total Discharges Crude Discharge Rate (Per 10,000 Population) Age-Adjusted Discharge Rate (Per 10,000 Population) KFH Panorama 29, % City Medical Center Service Area Antelope Valley 9, % (Service Area) Panorama City 20, % (Service Area) California 667, % Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, Source geography: ZIP Code. In KFH Panorama City Medical Center Service Area, it is evident that due to the lack of primary care access, the population living in health professional shortage areas with fewer FQHCs the preventable hospital event rates are much higher than the state (83.17 Per 100,000 Population). This could likely lead to an increase in chronic diseases, mental and other health related problems in the KFH Panorama City Medical Center Service Area. Sub-population experiencing greatest impact (disparities) In KFH Panorama City Medical Center Service Area, the ethnicity with the highest percent of people without a consistent source of primary care are Hispanic/Latino not far behind are Blacks, an Asian. At this time data is not available for American Indian/Alaskan Native.. Population by Race / Ethnicity, Percent without Consistent Source of Primary Care Report Area White Black Asian American Indian Alaskan Native KFH Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Hispanic / Latino Multi- Race 10.14% 18.03% 17.31% no data 19.33% 13.02% 10.14% 18.03% 17.31% no data 19.86% 13.03% 10.14% 18.03% 17.31% no data 19.14% 13.02% Area) California 9.45% 16.47% 15.49% 7.11% 19.03% 14.07% Note: This indicator is compared with the state average. Data Source: California Health Interview Survey (CHIS), Source geography: County (Grouping). 75 P a g e

79 Geographical areas of greatest impact (disparities) The entire KFH Panorama City Medical Center Service Area has a total of 20 FQHCs, 5 in Antelope Valley and 15 in Panorama City. The lack of FQHCs and access to primary care has a negative effect on the health outcome of these two areas of KFH - Panorama City Medical Center Service Area. Therefore, the entire KFH - Panorama City Medical Center Service Area needs an intervention to increase services to improve the health of the community residents. Associated drivers and risk factors what is driving the high rates Access to Primary Care in the community? The following factors are associated with access to primary care in the community. Factors marked with * are not meeting the state, national and/or Healthy People 2020 benchmark. The following list also includes community input: Socio-economic Poverty rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty* Lack of Health Insurance* No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost* Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Lack of knowledge about the health condition they have Do not take care of their health needs Access Issues Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of Access to Primary Care Federally Qualified Health Centers* Facilities designated as Health Professional Shortage Areas (HPSA)* Preventable hospital events* Transportation is a big issue Community Input What do community stakeholders think about the issue of Access to Primary Care? Access to primary care was identified as the most important health need in the KFH Panorama City Medical Center Service Area through both primary and secondary data collection. Health care access is crucial for the wellbeing of the community and vital to economic growth. The clinics need to be open longer in the evening for people who may work somewhere other than the Antelope Valley. Maybe also having Saturday clinics will help people who need to go to the doctor on a more regular basis. Historically there haven t been enough health care providers to take care of the underinsured or noninsured. LA County started opening clinics in remote areas. For all services that have been added and capacity that has been built just with AVCC alone over the last two years still has not been 76 P a g e

80 enough. Undocumented workers do not feel safe accessing county services. They feel they will be deported or arrested. Immigrants would still go to the Care-a-Van. Gaps in Health Services in AV: Everywhere! One of the biggest gaps is lack of specialists for those with chronic diseases. County has specialty clinics where we are supposed to refer our clients, but those clinics are backlogged for up to 3 to 6 months. Transportation: Because of the vast nature of the region and how far apart things are, transportation is an issue. Kern County residents can t come down to the AV for services because it is a different county. They end up in Bakersfield, an 80 mile trip. One trip to sign up and then another trip have to be made for actual appointment. Kern is working on a transportation solution with shuttles. Distances involved in AV are the issue. Those with health issues, disabilities or those who are low income tend to live in areas that are further out and more removed from urban areas. Without money for transportation people may not access needed healthcare services or follow up care. Assets: What are the community assets that can help to address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Overall, KFH Panorama City Medical Center Service Area is dealing with a lack of primary care doctors at a rate at 80 per 100,000 people. In addition, having fewer FQHCs (20) makes access to care more difficult. The KFH Panorama City Medical Center Service Area also has higher rates of people who do not have a regular doctor (16.31%) where approximately 67.86% of the population lives in an area that is designated as a medically underserved area. In addition to lack of transportation, and access to medical care along with fewer primary care physicians all contributes to the high numbers of preventable hospital events in KFH Panorama City Medical Center Service Area. 77 P a g e

81 About Asthma Why it is important? The National Institute of Health (NIH) defines Asthma as a chronic lung condition where the airways get inflamed and narrows causing wheezing, chest tightness, coughing and shortness of breath. The symptoms get worse during the night or early mornings. Asthma can affect people of all ages, and frequently begins in the childhood (NIH: Asthma, 2012). Per NIH, in the U.S, more than 25 million people have asthma and almost one third of them are children. Children who have wheezing or frequent respiratory infections are at a higher risk of developing asthma. Other risk factors include allergies, eczema and parents with a history of asthma. Asthma that developed in the childhood usually continues beyond 6 years of age (NIH: Asthma, 2012). The effects of asthma can be reduced by following the doctor s instructions, using the prescribed medication, avoiding allergens that trigger asthmatic attacks, and getting regular checkups (NIH: Asthma, 2012). Statistical Data Asthma Hospitalization (Adult) Report Area Health Need Profile: Asthma Patient Discharges for Asthma Percentage of Total Discharges Crude Discharge Rate (Per 10,000 Population) Age-Adjusted Discharge Rate (Per 10,000 Population) KFH Panorama City Medical 2,920 1% Center Service Area Antelope Valley (Service Area) % Panorama City (Service Area) 1, % California 59, % Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, Source geography: ZIP Code. KFH Panorama City Medical Center Service Area s asthma related hospitalization rates in both the Antelope Valley (12.45) and Panorama City (9.45) are higher than the state (8.90 per 10,000 population). Overall asthma hospitalization rate of KHF Panorama City Medical Center Service Area (10.25 per 10,000 population) is not meeting the state benchmark. Sub-populations experiencing greatest impact (disparities) Asthma seems to be high among Blacks, and Native American/Alaskan Natives in KFH - Panorama City Medical Center Service Area compared to other ethnicities. Since the data cannot be isolated for different ethnicities for unknown or other races, the data is not comparable to other ethnicities. However, the two highest rates exist among Blacks and Native American/Alaskan Natives. This would also apply to the state level data as well due to the same reasons. 78 P a g e

82 Population by Race (All Ages), Asthma Hospital Admissions Rate (Per 1,000 Hospitalization Events) Asthma Discharge Rate (Per 10,000 Population), By ZCTA, OSHPD, Over Under 2.01 Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, Source geography: ZIP Code. The total number of cases of asthma is high in the communities of Lancaster, Palmdale, California City, Littlerock, Rosamond, Van Nuys, Pacoima and North Hollywood. Associated drivers and risk factors What is driving the high rates of Asthma in the community? The following factors are associated with higher rates of asthma in the community. Factors marked with *are not meeting the state, national and/or Healthy People 2020 benchmark. The following list also includes community input: Socio-economic Health Behaviors Access Issues Poverty rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty Lack of Health Insurance Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Low literacy levels Lack of knowledge about the Tobacco Usage (Adult)* Tobacco Expenditure* Lack of fruit/vegetable consumption Poor eating habits (all ages) Consumption of fast foods Foods containing high amounts of sugar and fats High number of fast food restaurants Access to grocery stores No time for physical activity Unsafe neighborhoods No green space Poor lighting to go walking in the evening Cracked pavements Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of nutritional education 79 P a g e

83 health condition they have Do not take care of their health needs Physical Environment Clinical Care Health Outcomes Poor Air Quality (Particulate Matter 2.5) Community Input What do community stakeholders think about the issue of asthma? Community stakeholders had a number of reasons why they believe asthma prevalence is increasing in their community: Air pollution High winds Second hand smoking Asthma We have the highest rate in Southern California except for the 710 corridor (the problem in 710 corridor has to do with the large number of trucks that travel to and from port of Long Beach). The rate in the AV is also due to indigenous-airborne particulate, pollen and dust. Affordable housing causes people to move up here and those same people could have been from 710 corridor. Second hand smoke and smokers contribute to asthma as well. Community members shared that the high winds, air pollution and second hand smoking were some of the risk factors in their community for the high rates of asthma. Community members also identified the same health drivers that were identified on the CHNA platform. Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Pneumonia Vaccinations (Age 65)* Noncompliance with prescription medications Low Birth Weight Obesity (Adult) Obesity (Youth)* Overweight (Adult)* Overweight (Youth) Asthma is a health need in KFH - Panorama City Medical Center Service Area as marked by high rates of asthma related hospitalizations among adults. Other factors that contribute to the asthma rates include poverty (<100%, <200%, Children), poor air quality, low birth weight, tobacco usage among adults, adults not receiving pneumonia vaccinations, obesity/overweight among youth and adults. 80 P a g e

84 About Breastfeeding Why it is important? Breastfeeding has positive health benefits for both the child and the mother. Breastfeeding may possibly lower infant mortality rates. According to the National Institution for Health (NIH), breast milk has a balance of nutrients that help an infant not only grow stronger, but also reduces the risk of many common childhood infections and illnesses. Breastfeeding may help lower the risk of certain cancers in mothers who breastfeed their infants. NIH recommends that women who do not have any health problems should try to breastfeed their babies at least the first six months of the infant s life (NIH, 2012) Statistical Data Health Need Profile: Breastfeeding Percent Mothers Breastfeeding (Any) Report Area Total In- Hospital Births Mothers Breastfeeding (Any) Percent Mothers Breastfeeding (Any) KFH Panorama City 18,679 16, % Medical Center Service Area Antelope Valley (Service 5,077 4, % Area) Panorama City (Service Area) 13,602 12, % California 873, , % Note: This indicator is compared with the state average. Data Source: California Department of Public Health, In-Hospital Breastfeeding Initiation Data, Source geography: County. About 90.77% of the mothers in KFH Panorama City Medical Center Service Area reported as breastfeeding (any) their children. However, this percentage (90.77%) is lower than the state (91.74%) average. Antelope Valley has slightly lesser percentage (90.29%) of mothers reporting any breastfeeding compared to Panorama City (90.94%). Lactation education is crucial to help mothers understand the importance of breastfeeding. Percent of Mothers Breastfeeding (Exclusively) Report Area Total In- Hospital Births Mothers Breastfeeding (Exclusively) Percent Mothers Breastfeeding (Exclusively) KFH Panorama City Medical 18,679 8, % Center Service Area Antelope Valley (Service Area) 5,077 2, % Panorama City (Service Area) 13,602 6, % California 873, , % Note: This indicator is compared with the state average. Data Source: California Department of Public Health, In-Hospital Breastfeeding Initiation Data, Source geography: County. Sub-populations experiencing greatest impact (disparities) 81 P a g e

85 The disparities in breastfeeding exist among the young mothers with lower educational levels and income level, and race/ethnicity. According to The Child Health U.S.A 2011 report published by the U.S. Department of Health and Human Services states that children born to mothers who are over 30 years of age, with higher level of education have more chances of being breastfed compared to children of younger, less educated and lower income mothers. Associated drivers and risk factors What are the barriers for breastfeeding in the community? The following factors are associated with breastfeeding in the community. Factors marked with * are not meeting the state, national and/or Healthy People 2020 benchmark. The following list also includes community input: Socio-economic Poverty rate (< 100% FPL)* Population below 200% of Poverty Level* Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Low literacy levels Access Issues Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of nutritional education Community Input What do community stakeholders think about the issue of breastfeeding? Community leaders, health care providers and breastfeeding advocates reiterated the importance of breastfeeding to reduce the rates of overweight/obese children in KFH Panorama City Medical Center Service Area. Lactation education was brought up as one of the priority areas of health need per the community feedback. In addition, the lower rates of breastfeeding in KFH Panorama City Medical Center Service Area confirms the need for additional lactation education. Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary KFH Panorama City Medical Center Service Area s breastfeeding in both the Antelope Valley (90.29%) and Panorama City (90.94%) are lower compared to the state (91.74%). In addition, rates for breastfeeding exclusively in Antelope Valley (46.88%), and Panorama City (47.02%), are much lower than the state (60.63%) and not meeting the state benchmarks. Therefore, breastfeeding is a health need that needs interventions. 82 P a g e

86 Health Need Profile: Cardiovascular Disease About Cardiovascular Disease Why it is Important? Cardiovascular disease is a leading cause of death in the U.S. Cardiovascular disease includes heart disease and stroke. Coronary heart disease, one of the most common heart diseases, causes more than half of all the heart disease deaths in the United States. Coronary artery disease occurs when the arteries that supply blood to the heart are blocked by a waxy, fat like substance called plaque. Plaque gradually builds up and narrows the artery leading to atherosclerosis. Risk factors for cardiovascular disease (heart disease and stroke) include high blood cholesterol, high blood pressure, diabetes, tobacco use, overweight, obesity, diet, lack of physical activity, alcohol use, and family history, age, gender and ethnicity (CDC: Heart Disease and Stroke, 2012). Statistical data Heart Disease Mortality Report Area Total Population Average Annual Deaths Death Rate (Per 100,000 Population) KFH Panorama City Medical Center 1,511,828 1, Service Area Antelope Valley (Service Area) 419, Panorama City (Service Area) 1,092,488 1, California 36,634,623 44, HP 2020 Target <= Note: This indicator is compared with the Healthy People 2020 Target. Data Source: California Department of Public Health, Death Statistical Master File, Source geography: ZIP Code. Overall heart disease mortality in KFH - Panorama City Medical Center Service Area is higher ( Per 100,000 Population) than the state (131.34) and Healthy People 2020 (<=100.8). Stroke Mortality Rates (Per 100,000 Population) Report Area Total Population Average Annual Deaths Death Rate (Per 100,000 Population) KFH Panorama City Medical 1,511, Center Service Area Antelope Valley (Service Area) 419, Panorama City (Service Area) 1,092, California 36,634,623 13, Note: This indicator is compared with the state average. Data Source: California Department of Public Health, Death Statistical Master File, Source geography: ZIP Code Stroke mortality in Antelope Valley of KFH Panorama City Medical Center Service Area is higher (39.50 Per 100,000 Population) and is not meeting the state (39.46 Per 100,000 Population) benchmark. 83 P a g e

87 Geographic Area of Greatest Impact (Disparities) A review of The Nielson Co., Thomson Reuter 2012 zip code level data shows high estimated prevalence of congestive heart failure and heart attack in Pacoima, Sylmar, North Hills, Granada Hills, Valencia, Panorama City, North Hollywood, Lancaster and Palmdale (The Nielsen Company, Thomson Reuter, 2012). High numbers of coronary heart disease cases are evident in Pacoima, Sylmar, Granada Hills, Valencia, Sherman Oaks, Studio City, North Hollywood, Lancaster and Palmdale (The Nielsen Company.; Thomson Reuter, 2012). Estimated number of stroke cases is higher in Lancaster, Palmdale, and Rosamond, Pacoima, Sylmar, Van Nuys, Sherman Oaks, North Hollywood, Studio City and Valley Village in KFH - Panorama City Medical Center Service Area (The Nielsen Company, Thomson Reuters, 2012). Cardiovascular Disease Mortality, Rate (Per 100,000 Pop.), By ZCTA, CDPH, Over Under 80.1 Data Suppressed or No Data Stroke Mortality, Rate (Per 100,000 Pop.), By ZCTA, CDPH, Over Under 15.1 No Data or Data Suppressed 84 P a g e

88 Associated drivers and risk factors What is driving the high rate of heart disease mortality in the community? The following factors are associated with higher rates of heart disease mortality in the community. Factors marked with an * are not meeting the state/nation and/or HP 2020 benchmarks. The list also includes the input from the community stakeholders: Socio-economic Poverty rate (< 100% FPL)* Population below 200% of poverty level Children in Poverty Student reading proficiency (4 th grade)* Population with no high school diploma* High school graduation rate* Lack of Health Insurance Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Low literacy levels Lack of knowledge about the health condition they have Language barriers Do not take care of their health needs Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of nutritional education Health Outcomes Overweight (adults)* Obesity (adults)* Overweight (youth) Obesity (youth)* Diabetes prevalence* Diabetes Hospitalization (adult) Diabetes hospitalization (youth) Health Behaviors Heavy alcohol consumption Alcohol expenditures Physical inactivity (adults)* Physical inactivity (youth)* Tobacco usage (adult)* Tobacco expenditure Noncompliance with prescription medications Reasons for the lack of physical activity No time Unsafe neighborhoods No green space Poor lighting Cracked pavements Physical Environment Liquor store access Park access* Recreation and fitness facility access*. Walkability* 85 P a g e

89 Community Input What do community stakeholders think about the issue of heart disease mortality? Community stakeholders listed the following reasons as to why they feel heart disease is increasing in their community: High blood pressure High cholesterol Poor diet Noncompliance with medication Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Heart disease prevalence rates in KFH - Panorama City Medical Center Service Area are lower than the state and are meeting the benchmarks. Cardiovascular disease needs to be address due to the high mortality rate. While prevalence is in line with benchmarks, there are higher rates of mortality. This could be a result of the lack of access to primary care or the lack of health and disease management education. On the other hand, heart disease mortality is a health need in KFH - Panorama City Medical Center Service Area as marked by high mortality rates. Overweight, obesity among youth and adults is one of the contributing factors for the high rates of heart disease mortality. The health need is likely being impacted by poverty, low educational achievements, lack of physical activity, poor diet, risky behaviors (heavy drinking and tobacco use), and diabetes incidences including hospitalization among youth and adults. 86 P a g e

90 About Cervical Cancer Why it is important? Health Need Profile: Cervical Cancer According to the National Cancer Institute (NCI), cervical cancer occurs in the tissue of the cervix (the organ connecting uterus and vagina). This slow-growing, symptomless cancer can be detected by a Pap smear test. Human Papilloma Virus (HPV) almost always is the cause of cervical cancers. It is estimated that 12,170 new cases of cervical cancer have been reported in 2012 in the U.S with 4,220 deaths caused by cervical cancer. Most common risk factor for cervical cancer is HPV infection. However, risky behaviors such as smoking can increase the risk for cervical cancer. Cervical cancer risk can be decreased by getting regular screening tests (Pap smear) or receiving HPV vaccination (NCI, What You Need to Know about Cervical Cancer, 2012). Statistical data Cervical Cancer Incidence Rate (Per 100,000 Population) Report Area Total Population, ACS Annual Incidence, Average Annual Incidence Rate (Per 100,000 Population) KFH Panorama City Medical 1,565, Center Service Area Antelope Valley (Service Area) 416, Panorama City (Service Area) 1,148, California 36,308,528 3, United States 301,461,536 24,117 8 HP 2020 Target <= 7.1 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, Source geography: County. Cancer is a leading cause of death and it is important to identify each cancer individually to place intervention programs in place to reduce the burden of cancer incidences and mortality. Cervical cancer incidence rate in KFH - Panorama City Medical Center Service Area is higher than the state, the nation and the HP 2020 benchmarks. Even the state (8.30), or the nation (8) per 100,000 population cervical cancer rates are higher than the HP 2020 target rate and are not meeting the targeted benchmark. Ethnic data on the cervical cancer incidence for KFH - Panorama City Medical Center Service Area indicates that there is a high disparity exists among Hispanic/Latino, Whites and Asians. This is consistent with the state data. However, the national data shows the disparity to be among Hispanic/Latino, Blacks and then the White populations. Data on American Indian/Alaskan Natives is currently not available. 87 P a g e

91 Sub-populations experiencing greatest impact (disparities) Ethnic data on the cervical cancer incidence for KFH - Panorama City Medical Center Service Area indicates that there is a high disparity exists among Hispanic/Latino, Whites and Asians. This is consistent with the state data. However, the national data shows the disparity to be among Hispanic/Latino, Blacks and then the White populations. Cervical Cancer Incidence Rate (Per 100,000 Population) by Ethnicity Hispanic / Latino Asian Black White United States California Antelope Valley (Service Area) Panorama City (Service Area) Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, Source geography: County. Data for other ethnicities, such as American Indian/Alaskan Native or Hawaiian/Pacific Islander are not available at this time. Estimated number of cervical cancer cases in Lancaster, Palmdale, Ridgecrest, Granada Hills, North Hills, and North Hollywood are higher than the other communities in KFH - Panorama City Medical Center Service Area (The Nielsen Company, 2012, Thomson Reuters, 2012). Chlamydia Rate (Per 100,000 Population.) KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States 88 P a g e

92 Sexually Transmitted Diseases such as Chlamydia rates in KFH - Panorama City Medical Center Service Area are higher than the state and the U.S. The primary data collected demonstrated a concern about unsafe sexual practices among youth and adults. Community residents and stakeholders brought up the unsafe sexual practice repeatedly and suggested that education on safe sex and the effects of STD on the cervical cancer incidence might encourage safer sexual practices. Associated drivers and risk factors - What is driving the high rates of cervical cancer in the community? The following factors are associated with higher rates of cervical cancer in the community. Factors marked with * are not meeting the state, nation or Healthy People 2020 benchmarks. Demographics Socio-economics Health Behaviors Poverty rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty Lack of Health Insurance Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Low literacy levels Lack of knowledge about the health condition they have Language barriers Do not take care of their health needs Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of reproductive knowledge Lack of nutritional education Teen Births Inadequate Fruit/Vegetable Consumption (Adults)* Tobacco Usage (Adults)* Tobacco Expenditure* Fruit/Vegetable Expenditure* Alcohol consumption Tobacco Unsafe or unprotected sexual behaviors by youth and adults Noncompliance with prescription medications No time Unsafe neighborhoods No green space Poor lighting Physical Environment Clinical Care Health Outcomes Grocery Store Access WIC-Authorized Food Store Access* Population Living in Food Deserts Problems at school Cervical Cancer Screening (Pap Test)* Chlamydia Incidence* HIV Prevalence* HIV Hospitalization* Overweight (adults)* Obesity (youth)* Community Input What do community stakeholders think about the issue of cervical cancer incidence? 89 P a g e

93 Community stakeholders had a number of reasons for why they believed cervical cancer is increasing among community members: You know some young people think that nothing bad is going to happen to them. They don t practice safe sex and end up getting either pregnant or sick. We need more education about safe sexual practice to encourage our young people to be safer. Parents think that their kids are not having sex, but they are. Parents also need help with talking to their kids about sex and tell them that if they are not careful, they can get STDs. So, I think it is both (parents and kids) who need education. Not too many people understand the new vaccine for HPV, so may be giving information about that would help parents to understand why it is important to let their girls have those vaccines and may be that will help a bit too. Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Rates of cervical cancer mortality in KFH - Panorama City Medical Center Service Area are not meeting the benchmarks and it is health need in KFH - Panorama City Medical Center Service Area. The high rates of cervical cancer incidence is likely influenced by poverty rates (<100% and <200% FPL), children in poverty, teen births, inadequate fruit and vegetable consumption, tobacco use, cervical cancer screening rates, and the prevalence of HIV, Chlamydia, along with overweight and obesity. The primary data collected demonstrated a concern about unsafe sexual practices among youth and adults. Community residents and stakeholders brought up the unsafe sexual practice repeatedly. Education on safe sex and the effects of STD on the cervical cancer incidence might encourage safer sexual practices. 90 P a g e

94 Health Need Profile: Dental Health Services About Poor Dental Health - Why is it important? According to the Centers for Disease Control and Prevention reports that about 40% of poor adults ages 20 or more are identified as having at least one untreated decayed tooth compared to 16% of non-poor adults. In the past decade, the percent of adults 60 years or older how is missing all their teeth went down from 31% to 25%. The percent of people who are between the ages of 40 to 59 went down from 9 to 5%. However, that 5% means one out of 20 middle aged adults are missing all their teeth (CDC, Oral Health, 2012). Risk factors can be reduced by drinking fluoridated water, avoiding tobacco, limiting alcohol, healthy eating, and regular dental checkups including teeth cleaning (CDC, Oral Health for Adults: Fact Sheet, 2012). Statistical data Percent of Adults with Poor Dental Health Report Area Total Population (Age 18 ) Number Adults with Poor Dental Health Percent Adults with Poor Dental Health KFH - Panorama City 1,166, , % Medical Center Service Area (Service Area) Antelope Valley (Service 309,948 36, % Area) Panorama City (Service 856,755 99, % Area) California 27,311,960 3,078, % United States 232,747,222 36,229, % Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Source geography: County. KFH - Panorama City Medical Center Service Area has a higher percent of adults with poor dental health compared to the state and is not meeting the state benchmark. This could likely be due to the lack of access to dental care and/or barriers to utilization of dental services. Sub-populations experiencing greatest impact (disparities) National data from CDC reports that overall in the U.S, Blacks, Hispanics and American Indians/Alaskan Natives have poorest oral health compared to other ethnicities. Blacks, non- Hispanics and Mexican Americans ages between 35 to 44 years have twice as much untreated tooth decay compares to Whites and non-hispanics (CDC, Oral Health, 2012). Associated drivers and risk factors what is driving the high rates of poor oral health in the community? The following factors are associated with higher rates of poor oral health in the community. Factors marked with an * are not meeting the state and/or national benchmarks. The following table includes input from the community leaders, residents and health care providers. 91 P a g e

95 Socio-economic Health Behaviors Clinical Care Poverty Rate (< 100% Soft Drink Absence of Dental Insurance Coverage* FPL)* Expenditures* Dental Care Utilization (youth)* Population below 200% Poor eating habits (all Dental Care Utilization (adult)* of Poverty Level* ages) Dental Care Affordability* Children in Poverty* Consumption of soft Not seeking preventative services such as fluoride Lack of dental insurance drinks sealants, regular dental checkups including dental Lack of low cost dental Foods containing cleanings services high amounts of Lack of education/knowledge Lack of Access to sugar and fats Low literacy levels primary care High number of fast Lack of knowledge about the health condition they No regular doctor visits food restaurants have due to cost Language barriers Missed or no shows for Do not take care of their health needs follow up doctor s Lack of resources appointment due to cost Lack of culturally appropriate information about health issues and available resources Lack of nutritional education Lack of knowledge on the importance of maintaining good oral hygiene Lack of knowledge about poor dental health and how it impacts the overall health of a person Community Input What do community stakeholders think about the issue of poor oral health? Community stakeholders had a number of reasons for why they believed oral health is an issue in their community: Risky behaviors Not seeking dental services Missed follow up appointments Improper brushing techniques Assets what are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Oral health is a heath need in KFH - Panorama City Medical Center Service Area as marked by the prevalence of poor dental health and the percentage of adults who had six or more of their permanent teeth removed that are higher than the state average. The health need is likely being impacted by the poverty rates, lack of dental care access, consumption of soft drinks, lack of dental insurance and the poor dental care utilized by youth and adults. 92 P a g e

96 Health Need Profile: Diabetes About Diabetes - Why is it important? Diabetes is a condition that is a result of high blood sugar levels. There are three types of diabetes: Type I where the pancreas produces little or no insulin. Type II diabetes is a result of overweight and obesity where the body becomes resistant to insulin. The final type of diabetes is called Gestational diabetes where pregnant women who are free of diabetes in the past develop high blood sugar. Diabetes risk factors include being obese, age, heredity, race/ethnicity, poor dietary habits, and lack of physical activity or history of diabetes during pregnancy. According to the report published by the Los Angeles County Department of Public Health (LAC DPH) Trends in Diabetes: A Reversible Public Health Crisis diabetes rates have increased from 6.6% in 1997 to 9.1% in 2007 (LAC DPH, 2012). Type II is the most common diabetes and can be prevented by consuming whole grains, fruits and vegetables, limiting high fat or calorie foods, lean meat, fish, low-fat dairy products, reducing sweetened drinks, losing excess body weight and regular physical activity (LAC DPH, 2012). Statistical data Percent of population with Diabetes Report Area KFH - Panorama City Medical Center Service Area Total Population (Age 20 ) Population with Diabetes Percent with Diabetes 1,103,751 85, % Antelope Valley (Service Area) 292,227 22, % Panorama City (Service Area) 811,524 62, % California 26,721, ,022, % United States 239,583, ,015, % Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, National Diabetes Surveillance System, Source geography: County. The percentage of diabetes incidence in KFH - Panorama City Medical Center Service Area is higher than the state and not meeting the state benchmark. Diabetes is a chronic condition that could lead to other complications such as amputations, eye problems, and podiatric issues. Diabetes rates are high in the U.S and can indicate an unhealthy lifestyle of a person including insufficient fruit and vegetable consumption, lack of regular physical activity among others. 93 P a g e

97 Diabetes Hospitalization (Adult) Report Area Patient Discharges for Diabetes Percentage of Total Discharges Crude Discharge Rate (Per 10,000 Population) Age-Adjusted Discharge Rate (Per 10,000 Population) KFH - Panorama City 2, % Medical Center Service Area (Service Area) Antelope Valley % (Service Area) Panorama City (Service 1, % Area) California 58, % Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, Source geography: ZIP Code. Even though overall diabetes related hospitalization rates are meeting the state benchmark, Antelope Valley in the KFH - Panorama City Medical Center Service Area is higher than the state rate and is not meeting the benchmark. Sub-populations experiencing greatest impact (disparities) Diabetes Hospitalization by Ethnicity 2.00% 1.80% 1.60% 1.40% 1.20% 1.00% 0.80% 0.60% 0.40% 0.20% 0.00% White Black Asian / Pacific Islander Other Race / Multi-Race Unknown Race Hispanic / Latino KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, Source geography: ZIP Code. According to the data available, diabetes demonstrates high disparities among Black followed by other races and unknown race. The above graph provides a general overview of the diabetes hospitalization; however, due to the lack of clear definition of other races and unknown race, comparison between ethnicities would not be viable. Data on American Indian/Alaskan Native is currently unavailable. 94 P a g e

98 Associated drivers and risk factors What is driving the high rates of diabetes in the community? The following are associated with diabetes prevalence, diabetes hospitalizations among adult and youth in the community. Factors marked with an * are not meeting the state benchmarks. The following table includes the community input: Social and Economic Access Health Behaviors Poverty Rate (<100% FPL)* Population Below 200% of the Poverty Level* Children in Poverty* Lack of Health Insurance Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Inadequate Fruit/Vegetable consumption (adults and youth)* Soft drink consumption (youth) Physical Inactivity (adult and youth)* Soft drink expenditure* Fruit and vegetable expenditure Poor eating habits (all ages) Consumption of fast foods Foods containing high amounts of sugar and fats High number of fast food restaurants Access to grocery stores Alcohol consumption Tobacco No time Unsafe neighborhoods No green space Poor lighting Cracked pavements Physical Environment Clinical Care Health Outcomes Grocery Store Access* WIC-Authorized Food Store Access* Population Living in Food Deserts* Park Access* Walkability Recreation and Fitness Facility Access* Fast Food Restaurant Access Diabetes Management Hemoglobin A1c Test* Overweight (adult)* Overweight (youth)* Obesity (adult) Obesity (youth)* Community Input What do community stakeholders think about the issue of diabetes? Community members specifically identified lack of knowledge and shared that educational opportunities would help them to gain knowledge. In addition, the community members felt that providing health education will help them to be more proactive when it comes to their health. Listed below are the reasons the community members stated that diabetes is a problem in their community: 95 P a g e

99 Lack of education/knowledge Low literacy levels Lack of knowledge about the health condition they have Language barriers Do not take care of their health needs Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of nutritional education Assets What are the community assets that can address the health need? Additional community assets identified by the stakeholders include the following: Mobile diabetes van Diabetes teaching kitchen (Mission Community Hospital) Nutrition and physical activity classes San Fernando pool facility activities Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Diabetes is a health need in KFH - Panorama City Medical Center Service Area. Diabetes prevalence rates in KFH - Panorama City Medical Center Service Area did not meet the state benchmark. Data on the disparities show that Hispanic/Latinos, Blacks and Whites have a higher percentage of diabetes in KFH - Panorama City Medical Center Service Area. Other related indicators for the increase in diabetes prevalence, in KFH - Panorama City Medical Center Service Area could likely be a result of poverty, inadequate fruit and vegetable consumption, and physical inactivity. In addition, environmental factors such as access to fast food restaurants, lack of park access, walkability, lack of recreational and fitness facilities might likely be contributing to the high diabetes related health problems. It is also evident that the community residents do not seek preventative services and the community stakeholders reiterated that a high rate of patients is non-complaint with prescription medications. All these drivers could possibly be contributing to the high rates of diabetes in KFH - Panorama City Medical Center Service Area. 96 P a g e

100 Health Need Profile: Mental Health About Mental Health - Why is it important? Mental health is a key driver of health status. Economic and social insecurity often are associated with poor mental health. Poverty, unemployment, heavy alcohol and tobacco consumption, and physical inactivity affect mental health as well. Statistical data How is poor mental health measured? What is the prevalence of poor mental health in the community? Suicide Rate (per 100,000 population) KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California 8.70% 12.40% 7.40% 9.79% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California The rate of suicide is lower in KFH - Panorama City Medical Center Service Area (8.70%) compared to the state (9.79%), but is significantly higher in the Antelope Valley Service Area (12.40%). According to the community input, the main cause of suicide is lack of social and emotional support. Percent Adults Reporting Adequate Social Or Emotional Support KFH - Panorama City Medical Center Service Area Panorama City (Service Area) United States 71.19% 71.34% 71.13% Antelope Valley (Service Area) California 75% 80.33% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States The percentage of adults aged 18 and older who self-report receiving sufficient social and emotional support most of the time is significantly lower in KFH - Panorama City Medical 97 P a g e

101 Center Service Area (71.19%) than the state (75%) and the nation (80.33%). This indicator is relevant because social and emotional support is critical for navigating the challenges of daily life as well as for good mental health. Social and emotional support is also linked to educational achievement and economic stability. Sub-populations experiencing greatest impact (disparities) Age groups reflect high disparities among young adults to seniors. Middle-aged adults are the most affected by anxiety and depression. Percent of Adults With Current Anxiety and Depression by Age Group, 2011 Anxiety Depression 13.40% 13.80% 4.10% 4.10% 5.70% 6.10% 9.40% 7.60% 9.70% 7.60% 5.30% 8.50% Source: LAC DPH, 2013 Geographical areas of greatest impact (disparities) Percent Population, By PUMA, ACS Year Estimate Over Under 10.1 No Suicide Deaths No Data or Data Suppressed According to the Nielson Co, Thomson Reuter 2012 estimates, the communities of Lancaster, North Hills, North Hollywood, Pacoima, Palmdale, Panorama City, and Sylmar have the highest number of population with Anxiety and Depression (Nielson Co, Thomson Reuters, 2012). Associated drivers and risk factors What is driving the high rates of poor Mental Health in the community? 98 P a g e

102 The following factors are associated with higher rates of poor mental health in the community. Factors marked with an * are not meeting the state and/or national benchmarks. The following table includes input from the community leaders, residents and health care providers. Socio-economic and Behaviors Poverty Rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty* Unemployment* Heavy Alcohol Consumption Tobacco Usage and Expenditures* Physical Inactivity* Community Input What do community stakeholders think about the issue of Mental Health in their community? The lack of mental health care causes people to go untreated for years and years, which could be the reason for the higher rates of depression and suicide in the AV. No one is intervening. When those with a mental illness have a serious break and are admitted to the mental health ward at Antelope Valley Hospital, OliveView or Henry Mayo hospitals, they are released with a prescription for 30 days worth of medication and can wait up until 90 days for an appointment with DMH AV. In those 60 days without medications, patients have a high probability of coming back to the hospital on another 5150 call. It creates a revolving door environment. There used to be 60 mental health beds (including children) in five hospitals in AV when the population was at 50,000 and now with the current population over 400,000, we are down to one hospital with a mental health ward that has 6 to 12 mental health beds. The number of beds available depends on a patient to staff ratio of 6 patients to 1 nurse. People out sick or quitting will affect that number. Many clients are forced to go to Henry Mayo Hospital or OliveView hospital which is 35 to 60 miles away, respectively. This affects follow up case management and family support system. There is no real infrastructure for adult mental health. Resources and services are very spare. There are several children agencies that provide services, but there are no inpatient services for children. Other than L.A. County Department of Mental Health, mental health America is the only adult provider of mental health services in the AV serving 1,000 people last year. When you consider one in four adults is in need of mental health services and the AV has a population of more than 400,000 people, we are not even touching the need in the AV. The AV used to have 60 mental health beds between the old Palmdale Hospital and Lancaster where some of those beds were for children. We now have 6 to 12 beds at Antelope Valley Hospital with none for children. 99 P a g e

103 Stigma is also a factor. Many people consider that those with mental health issues have a character flaw and that somehow a person is not strong enough or not trying hard enough. Those same people wouldn t tell a person with diabetes or heart disease to buck up and handle it. Misinformation contributes to this stigma. More support from the community could help, and providing correct information can go a long way to reduce the stigma. Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Mental Health is a heath need in KFH - Panorama City Medical Center Service Area as marked by the prevalence of depression and anxiety, and the percentage of adults who report not receiving adequate social and emotional support. The health need is likely being impacted by the poverty rates, lack of social and emotional support, and lack of education to seek professional mental and behavioral services. 100 P a g e

104 Health Need Profile: Obesity/Overweight for Adult and Youth About Obesity/Overweight for Adult and Youth - Why is it important? The County of Los Angeles Public Health department s (LAC DPH) September 2012 article on the Trends in Obesity: Adult Obesity Continues to Rise, reports that Over the past decade, the obesity epidemic has emerged as one of the most significant public health threats in Los Angeles County and across the nation (Los Angeles County Department of Public Health, 2012). According to the World Health Organization (WHO), overweight or obesity is an accumulation of excess body fat that affects a person s overall health. Overweight and obesity is calculated by using the Body Mass Index where the weight of the person (in kilograms) divided by the square of their height (in meters). Overweight is a BMI equal to or more than 25 and obesity is where the BMI is over 30 (WHO, Obesity and overweight fact sheet, 2012). Overweight and obesity is one of the most preventable health problems and causes type II diabetes, which could potentially lead to other chronic diseases such as heart disease, stroke, arthritis and many forms of cancers. Obesity and overweight is not only prevalent among adults, but also children. According to the Trends in Obesity: Adult Obesity Continues to Rise published by the LAC DPH, in the year 2011, about 23.6% of the adults (18 years or older) in Los Angeles County were obese (Los Angeles County Department of Public Health, 2012). Statistical data Overweight Adults Report Area KFH - Panorama City Medical Center Service Area (Service Area) Student Population Number Percent Tested Obese Obese 55,406 18, % Antelope Valley (Service Area) 17,397 5, % Panorama City (Service Area) 38,009 12, % California 1,300, , % Note: This indicator is compared with the state average. Data Source: California Department of Education, Fitnessgram Physical Fitness Testing Results, Source geography: School District. This indicator reports the percentage of children in grades 5, 7, and 9 ranking within the "High Risk" category (Obese) for body composition on the Fitnessgram physical fitness test. Body composition is determined by skin fold measurements or bioelectrical impedance analysis for the calculation of percent body fat and/or Body Mass Index (BMI) calculation. The percent body fat "high risk" threshold is 27%-35.1% for boys and 28.4%-38.6% for girls, depending on age. The BMI "high risk" threshold is for boys and for girls, depending on age. This indicator is relevant because it is a measure of body's mass that is fat, and high levels of body fat are linked to obesity, heart disease, diabetes, and other health issues. 101 P a g e

105 Obese Youth Report Area Total Population Number Percent (Age 18 ) Overweight Overweight 1,166, , % KFH - Panorama City Medical Center Service Area (Service Area) Antelope Valley (Service Area) 309, , % Panorama City (Service Area) 856, , % California 27,311,960 9,886, % United States 232,747,222 84,521, % Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Source geography: County. Adult overweight rates are higher in KFH - Panorama City Medical Center Service Area and are not meeting the state and national benchmarks. However, adult obesity rates are better than state and national benchmarks. On the contrary, youth overweight rates are better than state benchmark but youth obesity in KFH - Panorama City Medical Center Service Area is not meeting the state benchmark. Sub-populations experiencing greatest impact (disparities) Students by Race / Ethnicity, Percent Obese ("High Risk" Fitness Zone) Report Area White Black Asian American Indian/ Alaskan Native KFH - Panorama City Medical Center Service Area (Service Area) Antelope Valley (Service Area) Panorama City (Service Area) Hispanic / Latino Multi- Race 20.50% 31.07% 19.14% 27.63% 39.75% 28.70% 24.76% 29.25% 18.39% 23.08% 37.49% 28.64% 19.30% 32.40% 19.18% 29.20% 40.61% 29.65% California 19.82% 30.27% 16.69% 19.97% 36.74% 23.89% Note: This indicator is compared with the state average Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract. The above table reflects the percentage of children in grades 5, 7, and 9 ranking within the "High Risk" or Needs Improvement zones for aerobic capacity on the Fitnessgram physical fitness test. Aerobic capacity is determined by VO2max, a measure of the maximum rate that oxygen can be taken up and utilized by the body during exercise. VO2max rates are estimated through a one mile run, a 20m PACER, or a walk test. The VO2max Healthy Fitness Zone threshold is for boys and for girls, depending on age. As age increases the VO2max threshold increases for boys, and decreases for girls. This indicator is relevant because a lack of 102 P a g e

106 physical fitness in children may lead to significant health issues, such as obesity, diabetes, and poor cardiovascular health. Pct. of Students In 'At High Risk' Body Composition Zone, By Elementary School District, CA Dept. of Education, 2011 Over 40.0% % % % Under 10.1% Students by Race / Ethnicity, Percent Overweight (Needs Improvement Fitness Zone) 18.00% 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% White Black Asian American Indian / Alaskan Native Hispanic / Latino Multi-Race Report Area Panorama City (Service Area) Antelope Valley (Service Area) California Ethnic data for obese youth demonstrates high disparities between Hispanic/Latino, Black and Non-Hispanic American Indian/Alaskan Native populations. Associated drivers and risk factors What is driving the high rates of overweight adults and obese youth in the community? The following are associated with higher rates of overweight adults and obese youth in the community. Factors marked with an * are not meeting the state benchmarks. The following table includes the community input on the risk factors and associated drivers for obesity and overweight among adults and youth in their community. 103 P a g e

107 Socio-economic Health Behaviors Physical Environment Poverty rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty* Lack of Health Insurance Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Inadequate Fruit/Vegetable consumption (adult)* Adequate Fruit/Vegetable Consumption (youth) Soft Drink Expenditures* Physical Inactivity (adult)* Physical Inactivity (youth)* Breastfeeding (Any) * Breastfeeding (Exclusive)* Fruit/Vegetable Expenditure Tobacco Usage (Adult)* Tobacco Expenditure* Poor eating habits (all ages) Consumption of fast foods Foods containing high amounts of sugar and fats High number of fast food restaurants Access to grocery stores Grocery Store Access* WIC-Authorized Food Store Access Population Living in Food Deserts Food Store Access Park Access* Walkability Recreation and Fitness Facility Access* Unsafe neighborhoods Poor lighting Cracked pavements Health Outcomes Diabetes Heart disease High blood pressure High cholesterol Stroke Cancers Education/Knowledge Lack of knowledge about the health condition they have Language barriers Do not take care of their health needs Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of nutritional education Community Input What do community stakeholders think about the issue of Overweight and Obesity? Community stakeholders believe poor eating habits and lack of physical activity are contributing to the high rates of overweight and obesity in their community. The participants discussed the following issues as contributors to overweight and obesity. Poor diet Fast food restaurants Lack of nutritional education 104 P a g e

108 Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Overweight adults and obese youth is a health need in KFH - Panorama City Medical Center Service Area as the rates of overweight adults and obese youth rates are higher than state average. The health need is likely being impacted by poverty rates, inadequate consumption of fruits and vegetables among adult populations in KFH - Panorama City Medical Center Service Area. In addition, physical inactivity, fast food access, lack of parks and walkability along with lack of recreational facilities are contributing to the high rates of overweight among adults and obesity among youth in KFH - Panorama City Medical Center Service Area. As discussed earlier, Hispanic/Latino, Black and non-hispanic American Indian/Alaskan Native youth are more impacted by obesity compared to other ethnicities in KFH - Panorama City Medical Center Service Area. 105 P a g e

109 About Physical Environment - Why is it important? Physical environment includes not only the geographical area where people live, but also the soil, water, weather and built environment. Environmental factors including built structures, quality of air, water, cleanliness of the community and safety can have either positive or negative impact on people s health. For example, parks, grocery stores, shops, entertainment, restaurants are all considered the environment where someone lives. Statistical data This indicator reports the number of grocery stores per 100,000 population. Grocery stores are defined as supermarkets and smaller grocery stores primarily engaged in retailing a general line of food, such as canned and frozen foods; fresh fruits and vegetables; and fresh and prepared meats, fish, and poultry. Included are delicatessen-type establishments. Convenience stores and large general merchandise stores that also retail food, such as supercenters and warehouse club stores are excluded. This indicator is relevant because it provides a measure of healthy food access and environmental influences on dietary behaviors. Grocery Stores Health Need Profile: Physical Environment/Transportation Report Area Total Population, 2010 Census Number of Establishments Establishment Rate (Per 100,000 Population) KFH - Panorama City 1,573, Medical Center Service Area (Service Area) Antelope Valley (Service 420, Area) Panorama City (Service 1,152, Area) California 37,253,956 8, United States 308,745,538 67, Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, County Business Patterns, Source geography: County. Park Access This indicator reports the percentage of population living within 1/2 mile of a park. This indicator is relevant because access to outdoor recreation encourages physical activity and other healthy behaviors. Data for this indicator is provided by a local source, if available. Park Access 106 P a g e

110 Report Area Total Population, 2010 Census Population Within 1/2 Mile Percent Within 1/2 Mile KFH - Panorama City Medical Center Service Area (Service Area) Antelope Valley (Service Area) Panorama City (Service Area) 1,574, , % 421,692 93, % 1,152, , % California 37,253,956 21,831, % Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, 2010 Census of Population and Housing, Summary File 1; Esri's USA Parks layer (compilation of Esri, National Park Service, and TomTom source data), Source geography: Block Group. The park access is not meeting the state benchmark. The Antelope Valley (22.28%) has less green space and park access compared to Panorama City (43.50%) and not meeting the state (58.60%) percentage. Sub-populations experiencing greatest impact (disparities) People living in the city face air pollution, water pollution, lack of green space, access to nature. All these factors could negatively impact their health. Environment pollutants and toxins such as asbestos, lead, rodents, and pests can cause physical illness and could harm the living environment. Not only air or water pollution, but noise pollution, lack of access to healthier food choices, lack of transportation, stress, and lack of social support can impact the overall health of an individual. Community Input What do community stakeholders think about the issue of physical environment? Community stakeholders had a number of reasons why they believed the physical environment is an issue in their community: Lack of access to parks Cracked pavements Poor street lights Unsafe neighborhood 107 P a g e

111 Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary The KFH Panorama City Medical Center Service Area has less green space and grocery store access. Both areas are not meeting the benchmarks. Grocery access in KFH Panorama City is (21.60) per 100,000 population and park access in AV (22.28%) and Panorama City (43.50%) are lower than the state average and are not meeting the need of the communities. Green space was a huge issue to many of the community residents. Therefore, a list of local parks is provided under resources in Appendix C. 108 P a g e

112 Health Need Profile: Poverty Rates About Poverty Rates Why it is important? Section 673(2) of the Omnibus Budget Reconciliation Act (OBRA) requires the Secretary of the Department of Health and Human Services to update the poverty income guidelines annually. The poverty levels are set to help families/households to file an affidavit called (Minimum Income Requirement for Use (I-864) form). This allows individuals and families to be enrolled into government assisted programs. The poverty guidelines are poverty thresholds used by the Census Bureau to make statistical estimation of people or families living in poverty (U.S. Department of Health and Human Services, 2013) Poverty Guidelines From the U.S. Department of Health & Human Services Persons in Family/Household <100% Federal Poverty Level Annual Income in $ 200% Federal Poverty Level Annual Income in $ 1 $11,490 $22,980 2 $15,510 $31,020 3 $19,530 $39,060 4 $23,550 $47,100 5 $27,570 $55,140 6 $31,590 $63,180 7 $35,610 $71,220 8 $39,630 $79,260 Source: U.S. Department of Health and Human Services, Poverty has a great impact on overall health because it minimizes an individual s or family s capacity to access services or basic needs for themselves. Poverty is significantly important because it creates barriers when accessing health services, healthy food, and other necessities that contribute to poor health status. Statistical data How is poverty measured? What is the prevalence of poverty in the community? Poverty <100% (FPL) KFH Panorama City Medical Center Service Area s poverty rates (<100%) in both Antelope Valley (18.68%) and Panorama City (13.74%) are higher than the state (13.71%) and the nation (13.82%). Overall poverty rate of KFH Panorama City Medical Center Service Area (15.04%) is not meeting state and/or the national poverty benchmarks. 109 P a g e

113 Poverty Rate (<100% FPL) Report Area Total Population (For Whom Poverty Status is Determined) Total Population in Poverty Percent in Poverty (100% FPL) KFH - Panorama City Medical 1,503, , % Center Service Area (Service Area) Antelope Valley (Service Area) 395,118 73, % Panorama City (Service Area) 1,108, , % California 35,877,036 4,919, % United States 296,141,152 40,917, % Note: This indicator is compared with the state average. No breakout data available. Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract. Poverty Rate 200% (FPL) Antelope Valley (40.9%) and Panorama City (35.40%) 200% federal poverty levels are higher than the state (32.83%) and the U.S (31.98%) benchmarks. As poverty impacts the ability of families/households affordability with dental, medical care, healthy food consumption and recreation, it is important to note the communities in KFH Panorama City Medical Center Service Area are adversely affected by poverty. KFH - Panorama City Medical Center Service Area 36.86% 40.97% 35.40% 32.83% 31.98% Antelope Valley (Service Area) Panorama City (Service Area) California Population with Income Below 200 % Poverty Level United States 110 P a g e

114 Sub-populations experiencing greatest impact disparities) Population by Race/Ethnicity, Percent in Poverty by Report Area 8% 12% 6% 8% 18% 5% White Black Asian Native American/Alaskan Native Native Hawaiian/Pacific Islander Some Other Race 13% 16% 14% Multiple Race Hispanic Non-Hispanic Sub-populations experiencing the greatest impact in KHF-Panorama City Medical Center Service Area are primarily Native Hawaiian/Pacific Islanders (26.81%), Blacks (29.94%), and Native Americans (22.17%). Geographical areas of greatest impact (disparities) Percentage of Total Population, By Tract, ACS Year Estimate Over 40.0% % % % Under 10.1% Households in KHF-Panorama City Medical Center Service Area that make less than $15,000 annually are primarily in (Northridge) with 22.45% of its residents making less than $15,000 a year, (Van Nuys) with 19.06%, and (North Hollywood) with 16.75% (The Nielsen Company., Thomson Reuters, 2012). Associated drivers and risk factors What is driving the high rates of poverty in the community? The following factors are associated with poverty rates in KFH - Panorama City Medical Center Service Area communities. Factors marked with * are not meeting the state, nation and/or Healthy People 2020 benchmarks. 111 P a g e

115 Socio-Economic Population with No High School Diploma* High School Graduation Rate* Unemployment Rate* Student Reading Proficiency (4 th Grade)* Health Outcomes Poor General Health* Premature Death Population with any Disability Community Input What do community stakeholders think about the issue of poverty? Community members expressed concern about unemployment and loss of jobs. Poverty rates in KFH Panorama City Medical Center Service Area are higher than the state and the U.S. Community stakeholders were concerned that the unemployment rates have contributed to the increasing rate of homeless population and the demand for food and free services have increased over the past few years. Assets What are the community assets that can address the health need? The assets listed above are randomly selected from a long list of assets available. For a comprehensive list of community assets and resources to address the health need, please refer to Appendix C. Summary Poverty is considered a key driver of health status because it influences other negative health outcomes. It creates barriers for families and individuals when seeking access to health care services or basic needs such as healthy/affordable food and other daily necessities. The related indicators that were identified as contributing to poverty rates in KFH - Panorama City Medical Center Service Area include: poor general health, premature death, and population disability; among many others. 112 P a g e

116 About Prenatal Care - Why is it important? Prenatal care is vital to keep both the mother and the child healthy during and after pregnancy. Women who receive prenatal care are less likely to give birth to an underweight or premature baby. Babies born to mothers that do not receive prenatal care are three times more likely to have low birth weight and five times more likely to die (U.S. Department of Health and Human Services Office on Women s Health, 2009). With regular prenatal care, women can help prevent and reduce the risk of pregnancy and infant complications as well as inform themselves about the important steps they can take to protect their infant and ensure a healthy pregnancy (Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2012). Statistical data How is prenatal care measured? What is the prevalence of women that lack prenatal care in the community? Report Area Total Population Health Need Profile: Prenatal Care Total Live Births Prenatal Care Started in 2nd Trimester Prenatal Care Started in 3rd Trimester No Prenatal Care Total Mothers with Late or No Prenatal Care Percent Mothers with Late or No Prenatal Care KFH - 2,122,785 26,181 2, , Panorama City Medical Center Service Area (Service Area) Antelope 419,491 6,247 1, , % Valley (Service Area) Panorama 1,152,451 15,579 1, , % City (Service Area) California 37,253, ,979 no data no data no data 15, % Note: This indicator is compared with the state average. No breakout data available. Data Source: California Department of Public Health, Birth Profiles by ZIP Code, Source geography: ZIP Code. 113 P a g e

117 KFH - Panorama City Medical Center Service Area Panorama City (Service Area) Antelope Valley (Service Area) California 32.05% 16.84% 10.75% 3.14% Mothers with late or no Prenatal Care The percent of mothers who receive late or no prenatal care (during their first trimester) in KFH - Panorama City Medical Center Service Area (9.68%) is significantly higher compared to the state (3.14%), but more prominently so in the Antelope Valley Service Area (32.05%). This indicator highlights a lack of access to preventative care, a lack of health knowledge, insufficient provider outreach, and/or social barriers preventing utilization of services. Sub-populations experiencing greatest impact (disparities) Population by Race/Ethnicity, Infant Mortality Rate (Per 1,000 Live Births) Report Area Antelope Valley (Service Area) Panorama City (Service Area) California United States White Black Asian American Indian/Alaskan Native Hispanic/Latino Infant mortality is a related indicator and health outcome of lack of prenatal care. Infant mortality rates affect more Blacks (11.57) than any other subpopulation across the KFH - Panorama City Medical Center Service Ares compared to the state and/ or the nation. 114 P a g e

118 Geographical areas of greatest impact (disparities) New Mothers with Late or No Prenatal Care, Percent, By ZCTA, CDPH, 2010 Over 30.0% % % % Under 6.1% No Data or Data Suppressed Geographical areas of greatest impact are prominently seen in the Antelope Valley Service Area where more than thirty percent of new mothers receive either late or no prenatal care. Although zip code level is not readily available for this area, the Los Angeles Department of Public Health has published a report which states that only 66.7 percent of mothers in Antelope Valley received prenatal care during their first trimester (Key Indicators of Health, 2013). Currently, Antelope Valley is fairing worse in prenatal care than the other seven Service Planning Areas. Associated drivers and risk factors What is driving the high rates of the lack of prenatal care in the community? The following factors are associated with higher rates of the lack of prenatal care in the community. Factors marked with an * are not meeting the state and/or national benchmarks. The following table includes input from the community leaders, residents and health care providers. Socio-economic & Health Behaviors Poverty Rate (< 100% FPL)* Population below 200% of Poverty Level* Unemployment* Uninsured Population Population with no High School Diploma Student Reading Proficiency (4 th Grade) Tobacco Usage (Adult) Health Outcomes Low Birth Weight* Infant Mortality* Teen Pregnancy 115 P a g e

119 Community Input What do community stakeholders think about the issue of prenatal health in their community? Community health care providers expressed concern with the number of expectant mothers getting prenatal care in both Antelope Valley and Panorama City areas of KFH Panorama City Medical Center Service Area. Health care providers suggested that providing education to expectant mothers on nutrition, dental care, and breastfeeding would reduce the infant low birth weight, childhood dental carriers and obesity. Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Prenatal care is a heath need in KFH - Panorama City Medical Center Service Area. The rates of mothers who receive late or no prenatal care are high in KFH - Panorama City Medical Center Service Area (9.68%) and not meeting the state (3.14%) benchmark. Antelope Valley has a higher need for prenatal care services/intervention programs when compared to Panorama City Service Area, although, both are not meeting the state benchmark. The health need is likely being impacted by lack of knowledge and access to primary health care which can be associated with high poverty rates. Additionally, unemployment, lack of insurance, reading proficiencies, tobacco use, and teen pregnancies are like influencing the health need. The latter indicators are also contributing to low birth weights and infant mortality which lower overall infant health. 116 P a g e

120 Health Need Profile: Unemployment About Unemployment: Why is it important? Unemployment is calculated for the civilian non-institutionalized population age 16 and older that is unemployed (non-seasonally adjusted). Unemployment creates financial instability and barriers to access including insurance coverage, health services, healthy food, and other necessities that contribute to poor health status. Statistical data Table: Unemployment Rate Report Area Labor Force Number Employed KFH Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) Number Unemploye d Unemploymen t Rate 782, ,601 78, , ,960 21, , ,641 57, California 18,557,689 16,817,161 1,740, United States 1,063,513, ,936,688 81,576, Note: This indicator is compared with the state average. Data Source: U.S. Bureau of Labor Statistics, December, 2012 Local Area Unemployment Statistics. Source geography: County. KFH Panorama City Medical Center Service Area s unemployment rates in both the Antelope Valley (10.24) and Panorama City (9.93) are higher than the state (9.40) and the nation (7.67). Overall unemployment rate of KFH - Panorama City Medical Center Service Area (10.01) is not meeting the state and/or the national unemployment benchmarks. Barriers for securing employment include not graduating from high school, reading below 4 th grade level and high school graduation rates. In KFH Panorama City Medical Center Service Area, all these issues have been identified as not meeting the state and the national averages. Population without High School Diploma Percentage of the population without high school diploma is higher in KFH Panorama City Medical Center Area (23.77%) compared to the state (19.32%) and the U.S. (14.97%). Within KFH - Panorama City Medical Center Area, Panorama City has the highest percentage (24.25%) of people without high a school diploma compared to Antelope Valley (22.30%). 117 P a g e

121 Graph 10: Percent of Population without High School Diploma 23.77% 22.30% 24.25% 19.32% 14.97% PFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Source geography: Tract. High School Graduation Rate On time graduation rates are lower in the KFH - Panorama City Medical Center Service Area. Panorama City (75.93%) and Antelope Valley (79.48%) compared to the state (82.27%) and the U.S. (82.26%). In addition to faring worse than the state and nation they are not meeting the HP 2020 Target (>82.4%). Community leaders and agency partners who participated in key informant interviews and focus groups expressed concern about the literacy levels of the community and fear that the cycle of poverty will continue without the knowledge to obtain higher paying jobs. Table 24: Percent of Students Graduating on Time Report Area Total Student Enrollment Average Freshman Base Enrollment Diplomas Issued On-Time Graduation Rate KFH - Panorama City Medical 87,191 21,663 16, Center Service Area Antelope Valley (Service Area) 28,388 5,342 4, Panorama City (Service Area) 58,803 16,321 12, California 1,971, , , United States 14,815,258 3,745,141 3,080, HP 2020 Target >82.4 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: U.S. Department of Education, National Center for Education Statistics (NCES), Common Core of Data, Local Education Agency (School District) Universe Survey Dropout and Completion Data, Source geography: School District. Students Reading below 4 th Grade Level The overall percentage of students reading below the 4 th grade level in KFH Panorama City Medical Center Service Area is much higher (40.54%) compared to the state (35.64%), the U.S (28.63%) and the HP 2020 target rate of <=36.3%. KFH Panorama City Medical Center 118 P a g e

122 Service Area, Antelope Valley s percentage (47.72%) is higher compared to Panorama City s percentage (37.22%). This issue was identified as a high level of concern in the community by the community leaders, educators and stakeholders during the primary data collection process. Low literacy levels were identified as possible reasons for rates of unemployment, poverty, and poor general health. Respondents also noted that the low literacy levels of residents of the community created barriers to health education and the reading of distributed printed materials. Geographical areas of greatest impact (disparities) Population without high school diploma are high in communities of Pacoima (33%), San Fernando (29.0%), Panorama City (25.5%), Sun Valley (23.1%) and North Hollywood (24.3%), Littlerock (19.1%), Llone (16.3%), Palmdale (12.58%) and Lancaster (23.3%) are specific communities in the KFH- Panorama City Medical Service Area that have more than 20% of the population over age 25 with less than a 9 th grade education (U.S. Census Bureau, American Community Survey). Associated drivers and risk factors What is driving the high rates of unemployment in the community? Socio-economic Population without High School Diploma Students Reading below 4 th Grade Level High School Graduation Rate *Shows that those indicators did not meet the state, U.S benchmarks Community Input What do community stakeholders think about the issue of Unemployment in their community? Community leaders shared their concerns regarding lack of English and language proficiency, math skills, and high school dropout rates, stating these reflect negatively on the wellbeing and growth of the communities they live in. Other issues brought up by the community stakeholders include: Lack of jobs Lack of skilled workers Budget cuts Furloughs days Reduced work hours Underemployment Assets What are the community assets that can address the health need? 119 P a g e

123 Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary KFH Panorama City Medical Center Service Area s unemployment rates in both the Antelope Valley (10.24) and Panorama City (9.93) are higher than the state (9.40) and the nation (7.67). Overall unemployment rate of KFH - Panorama City Medical Center Service Area (10.01) is not meeting the state and/or the national unemployment benchmarks. Other factors possibly contributing to the high rate of unemployment in KFH Panorama City Medical Center Service Area include not graduating from high school, reading below 4 th grade level and high school graduation rates. Barriers for securing employment will create barriers to employer provided health insurance. Lack of insurance in turn creates barriers to access to primary and preventative care leading to elevated number of health related issues. 120 P a g e

124 Health Need Profile: Uninsured Population About Uninsured - Why is it important? Health insurance is a key driver of health status. Economic and social insecurity often are associated with poor health. Poverty, unemployment, and lack of health insurance affect access to health care and community s ability to engage in healthy behaviors. Due to the current health care system in the U.S. and the cost of health care, people without health insurance may not receive needed health care. Statistical data How is poor dental health measured? What is the prevalence of oral health in the community? Percent Uninsured 20.81% 16.47% 22.37% 17.92% 15.05% Report Area Antelope Valley (Service Area) Panorama City (Service Area) California United States The rate of uninsured population is much higher in KFH - Panorama City Medical Center Service Area (20.81%) compared to the state (17.92%) and the U.S. (15.05%). Lack of insurance is a barrier to healthcare access including regular primary care, specialty care, and other health services and contributes to poor health outcomes. Sub-populations experiencing greatest impact (disparities) Ethnic data reflects high disparities among Hispanic/Latino, Native American/Alaskan Native, followed by Black and White % Percent of Uninusred Population by Ethnicity Report Area 30.00% 20.00% 10.00% 0.00% Antelope Valley (Service Area) Panorama City (Service Area) California United States 121 P a g e

125 Geographical areas of greatest impact (disparities) Percent Population, By PUMA, ACS Year Estimate Over 25.0% % % % Under 6.1% According to the Nielson Co, Thomson Reuter 2012 estimates, the communities of Lancaster, North Hills, North Hollywood, Pacoima, Palmdale, Panorama City, Sun Valley, Sylmar and Van Nuys have the highest number of population without health insurance (Nielson Co, Thomson Reuters, 2012). Associated drivers and risk factors What is driving the high rates of uninsured in the community? The following factors are associated with higher rates of uninsured in the community. Factors marked with an * are not meeting the state and/or national benchmarks. The following table includes input from the community leaders, residents and health care providers. Socio-economic Poverty Rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty* Unemployment Community Input What do community stakeholders think about the issue of Uninsured in their community? Community stakeholders had a number of reasons for why they believed oral health is an issue in their community: Lack of healthcare insurance and transportation are the biggest barriers to receiving healthcare. Over 90% of Antelope Valley Community Clinic s clients are low income, 40% don t have healthcare insurance at all. Many illnesses such as diabetes, asthma and heart disease can start with poor nutrition, be present because of family history (if known) and not be discovered before reaching the critical stage if individuals and families don t have the money for insurance or the money to pay cash at the doctors. 122 P a g e

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